Provider Demographics
NPI:1265855449
Name:SHIBER, ROXANN
Entity Type:Individual
Prefix:MS
First Name:ROXANN
Middle Name:
Last Name:SHIBER
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 1:100 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:17868-0367
Mailing Address - Country:US
Mailing Address - Phone:570-271-2065
Mailing Address - Fax:215-616-0150
Practice Address - Street 1:100 AVENUE C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:PA
Practice Address - Zip Code:17868-0367
Practice Address - Country:US
Practice Address - Phone:570-271-2065
Practice Address - Fax:215-616-0150
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013269363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health