Provider Demographics
NPI:1295397206
Name:ROCHE, YOLANDA MARIE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:MARIE
Last Name:ROCHE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N HICKORY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3700
Mailing Address - Country:US
Mailing Address - Phone:574-220-4778
Mailing Address - Fax:
Practice Address - Street 1:1001 N HICKORY RD STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3700
Practice Address - Country:US
Practice Address - Phone:574-220-4778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267670163WG0000X
IN28165052A163WG0000X
IN71009578A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71009578BOtherCONTROLLED SUBSTANCES REGISTRATION
IN71009578BOtherCONTROLLED SUBSTANCES REGISTRATION