Provider Demographics
NPI:1346424496
Name:ROACH, KATHLEEN A (RN PHN)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:ROACH
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:POINT REYES
Mailing Address - State:CA
Mailing Address - Zip Code:94956
Mailing Address - Country:US
Mailing Address - Phone:415-473-3808
Mailing Address - Fax:415-473-3828
Practice Address - Street 1:100 6TH STREET
Practice Address - Street 2:
Practice Address - City:POINT REYES
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-473-3808
Practice Address - Fax:415-473-3828
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292634163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management