Provider Demographics
NPI:1225187834
Name:ROESCH, WARREN W (RNFA)
Entity Type:Individual
Prefix:MR
First Name:WARREN
Middle Name:W
Last Name:ROESCH
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-845-1501
Mailing Address - Fax:985-845-1601
Practice Address - Street 1:2525 SEVERN AVE
Practice Address - Street 2:OMEGA HOSPITAL
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5932
Practice Address - Country:US
Practice Address - Phone:504-832-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN050984163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN050984OtherLICENSE #