Provider Demographics
NPI:1356669519
Name:RODERICK, JUNE D (NP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:D
Last Name:RODERICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3718
Mailing Address - Country:US
Mailing Address - Phone:888-393-9616
Mailing Address - Fax:258-366-9616
Practice Address - Street 1:3355 LENOX RD NE
Practice Address - Street 2:SUITE 750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1394
Practice Address - Country:US
Practice Address - Phone:888-393-9616
Practice Address - Fax:258-366-9616
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH11353363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health