Provider Demographics
NPI:1326030412
Name:ROACH, SHERI LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:ROACH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12339 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8148
Mailing Address - Country:US
Mailing Address - Phone:515-263-9107
Mailing Address - Fax:515-265-9888
Practice Address - Street 1:303 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3126
Practice Address - Country:US
Practice Address - Phone:515-243-4241
Practice Address - Fax:515-243-0209
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-070928363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q12163Medicare UPIN