Provider Demographics
NPI:1255004537
Name:ROACH, FRANCES (HAIR REPLACEMENT SPE)
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GINSENG ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9590
Mailing Address - Country:US
Mailing Address - Phone:910-670-3050
Mailing Address - Fax:
Practice Address - Street 1:3035 LEGION RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-3637
Practice Address - Country:US
Practice Address - Phone:910-670-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC946061744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management