Provider Demographics
NPI:1245745231
Name:ROESEL, EMMY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:ROESEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16738 W NATOMA DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-6236
Mailing Address - Country:US
Mailing Address - Phone:815-370-9533
Mailing Address - Fax:
Practice Address - Street 1:20960 S FRANKFORT SQUARE RD STE C
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-5127
Practice Address - Country:US
Practice Address - Phone:815-469-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016971363LF0000X
IN71007877A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily