Provider Demographics
NPI:1013997071
Name:ROEHM, WILLIAM LEE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEE
Last Name:ROEHM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8 AUTUMN OAK WAY
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-4066
Mailing Address - Country:US
Mailing Address - Phone:864-836-6151
Mailing Address - Fax:864-836-6157
Practice Address - Street 1:8 AUTUMN OAK WAY
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-4066
Practice Address - Country:US
Practice Address - Phone:864-836-6151
Practice Address - Fax:864-836-6157
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR59305163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse