Provider Demographics
NPI:1326021320
Name:ROCHE, ELLEN M (FNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:ROCHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 HOEN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7824
Mailing Address - Country:US
Mailing Address - Phone:707-542-1611
Mailing Address - Fax:707-542-9958
Practice Address - Street 1:4750 HOEN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7824
Practice Address - Country:US
Practice Address - Phone:707-542-1611
Practice Address - Fax:707-542-9958
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA237030363LF0000X
CANP793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEX364YMedicare PIN