Provider Demographics
NPI:1629355284
Name:ROACH, ELENA M (CPNP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:ROACH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8146 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2324
Mailing Address - Country:US
Mailing Address - Phone:513-588-3623
Mailing Address - Fax:513-728-4064
Practice Address - Street 1:8146 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2324
Practice Address - Country:US
Practice Address - Phone:513-588-3623
Practice Address - Fax:513-728-4064
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-12913363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP12913OtherOH LICENSE
OH0057745Medicaid
OHH214310Medicare PIN