Provider Demographics
NPI:1922327857
Name:DALE, ROXANNE (RN)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:RAE
Other - Last Name:MOREHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-472-4357
Mailing Address - Fax:512-703-1394
Practice Address - Street 1:6222 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4004
Practice Address - Country:US
Practice Address - Phone:512-206-4062
Practice Address - Fax:512-380-9758
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse