Provider Demographics
NPI:1093195414
Name:ROE, ROXANNE
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 W BEECHER ST
Mailing Address - Street 2:APT 43
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3162
Mailing Address - Country:US
Mailing Address - Phone:517-438-8960
Mailing Address - Fax:
Practice Address - Street 1:659 W BEECHER ST
Practice Address - Street 2:APT 43
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3162
Practice Address - Country:US
Practice Address - Phone:517-438-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other