Provider Demographics
NPI:1588835482
Name:MARKHAM, ROXANNE R (LPN)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:R
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 CAMELOT BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7488
Mailing Address - Country:US
Mailing Address - Phone:920-452-9994
Mailing Address - Fax:
Practice Address - Street 1:2105 CAMELOT BLVD
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-7488
Practice Address - Country:US
Practice Address - Phone:920-452-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse