Provider Demographics
NPI:1922428200
Name:ROETS, IDA (RN)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:ROETS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 STAFFORD WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3333
Mailing Address - Country:US
Mailing Address - Phone:530-671-9900
Mailing Address - Fax:855-319-4725
Practice Address - Street 1:1095 STAFFORD WAY
Practice Address - Street 2:SUITE D
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3333
Practice Address - Country:US
Practice Address - Phone:530-671-9900
Practice Address - Fax:855-319-4725
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse