Provider Demographics
NPI:1477944429
Name:ROACH, DENVER E (RN)
Entity Type:Individual
Prefix:MR
First Name:DENVER
Middle Name:E
Last Name:ROACH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 GOSLING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6510
Mailing Address - Country:US
Mailing Address - Phone:614-633-5521
Mailing Address - Fax:
Practice Address - Street 1:2785 GOSLING WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6510
Practice Address - Country:US
Practice Address - Phone:614-633-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.274966163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health