Provider Demographics
NPI:1659621977
Name:ROEPKE, NAOMI RAE (CNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:RAE
Last Name:ROEPKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:RAE
Other - Last Name:KAVANAGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-829-2861
Mailing Address - Fax:
Practice Address - Street 1:35205 COUNTY ROAD 3
Practice Address - Street 2:
Practice Address - City:CROSSLAKE
Practice Address - State:MN
Practice Address - Zip Code:56442
Practice Address - Country:US
Practice Address - Phone:218-692-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174582-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily