Provider Demographics
NPI:1376899310
Name:ROISMAN, DEVORAH COHEN (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:COHEN
Last Name:ROISMAN
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:GIPSMAN
Other - Last Name:ROISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP
Mailing Address - Street 1:1411 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1018
Mailing Address - Country:US
Mailing Address - Phone:510-437-4800
Mailing Address - Fax:
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22157363LX0001X
CA2007367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology