Provider Demographics
NPI:1851527949
Name:ALTEMUS, ROXANNE (DNP-CRNP)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:ALTEMUS
Suffix:
Gender:F
Credentials:DNP-CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1625
Mailing Address - Country:US
Mailing Address - Phone:814-534-0745
Mailing Address - Fax:814-536-5431
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1628
Practice Address - Country:US
Practice Address - Phone:814-535-2277
Practice Address - Fax:814-539-0475
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN314918L163W00000X, 163WP0808X
PASP016419363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023255810001Medicaid