Provider Demographics
NPI:1598515363
Name:ROELL, MICHELE RENEE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:ROELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 STOCK RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-9580
Mailing Address - Country:US
Mailing Address - Phone:937-248-6103
Mailing Address - Fax:
Practice Address - Street 1:7441 STOCK RD
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-9507
Practice Address - Country:US
Practice Address - Phone:937-336-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.4993893747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider