Provider Demographics
NPI:1033404603
Name:ROTH, REBECCA FIELDS (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:FIELDS
Last Name:ROTH
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:138 DUBLIN SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8600
Mailing Address - Country:US
Mailing Address - Phone:336-362-0241
Mailing Address - Fax:336-676-1380
Practice Address - Street 1:7163 CHARNEL LN
Practice Address - Street 2:
Practice Address - City:CLIMAX
Practice Address - State:NC
Practice Address - Zip Code:27233-9171
Practice Address - Country:US
Practice Address - Phone:336-362-0241
Practice Address - Fax:336-676-1380
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2017-03-22
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Provider Licenses
StateLicense IDTaxonomies
NC5005187363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology