Provider Demographics
NPI:1760785901
Name:ROACH, LENORE M (ANP)
Entity Type:Individual
Prefix:MS
First Name:LENORE
Middle Name:M
Last Name:ROACH
Suffix:
Gender:F
Credentials:ANP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DPET. OF SURGERY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-2775
Practice Address - Fax:804-828-0191
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168877363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health