Provider Demographics
NPI:1134471345
Name:ROEDER, VIRGINIA C (RN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:ROEDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 GLEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-8497
Mailing Address - Country:US
Mailing Address - Phone:330-770-3124
Mailing Address - Fax:
Practice Address - Street 1:14830 GLEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-8497
Practice Address - Country:US
Practice Address - Phone:330-770-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN370885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse