Provider Demographics
NPI:1003276775
Name:ROESCH, CHRISTINA A (LPN,EMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:ROESCH
Suffix:
Gender:F
Credentials:LPN,EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 N WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1521
Mailing Address - Country:US
Mailing Address - Phone:516-209-9648
Mailing Address - Fax:
Practice Address - Street 1:361 N WYOMING AVE
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1521
Practice Address - Country:US
Practice Address - Phone:516-209-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse