Provider Demographics
NPI:1710331590
Name:QUADERER, ROXIE LYNN
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:LYNN
Last Name:QUADERER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13380 W TREPANIA RD
Mailing Address - Street 2:LAC COURTE OREILLES COM HEALTH CTR
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-2186
Mailing Address - Country:US
Mailing Address - Phone:715-638-5142
Mailing Address - Fax:715-634-2740
Practice Address - Street 1:13380 W TREPANIA RD
Practice Address - Street 2:13380 W TREPANIA ROAD
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-2186
Practice Address - Country:US
Practice Address - Phone:715-638-5142
Practice Address - Fax:715-634-2740
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11498124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist