Provider Demographics
NPI:1558691238
Name:ROFF, VICKI LYNN (RN, MS, PHN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:ROFF
Suffix:
Gender:F
Credentials:RN, MS, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 BALSAM RD NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-7728
Mailing Address - Country:US
Mailing Address - Phone:218-751-0674
Mailing Address - Fax:218-759-1519
Practice Address - Street 1:6248 BALSAM RD NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-7728
Practice Address - Country:US
Practice Address - Phone:218-751-0674
Practice Address - Fax:218-759-1519
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 124141-5163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health