Provider Demographics
NPI:1679568489
Name:ROCHE, REBECCA J (CRNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:ROCHE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:HOLZER CLINIC INC.
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631
Mailing Address - Country:US
Mailing Address - Phone:740-446-5890
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:HOLZER CLINIC
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-5890
Practice Address - Fax:740-446-5982
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131550367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0756347Medicaid
OHRO8203887Medicare ID - Type Unspecified