Provider Demographics
NPI:1770957789
Name:ROTH, QUYEN T (MSN, RN, NP-C)
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:T
Last Name:ROTH
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 STATE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3614
Mailing Address - Country:US
Mailing Address - Phone:330-253-9727
Mailing Address - Fax:330-926-5866
Practice Address - Street 1:3033 STATE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3614
Practice Address - Country:US
Practice Address - Phone:330-253-9727
Practice Address - Fax:330-926-5866
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17776-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner