Provider Demographics
NPI:1912518481
Name:ROETHER, SHANA CHRISTINE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:CHRISTINE
Last Name:ROETHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SMITH STREET
Mailing Address - Street 2:PO BOX 186
Mailing Address - City:MILFORD
Mailing Address - State:KS
Mailing Address - Zip Code:66514-4030
Mailing Address - Country:US
Mailing Address - Phone:785-761-5725
Mailing Address - Fax:
Practice Address - Street 1:103 SMITH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:KS
Practice Address - Zip Code:66514-5049
Practice Address - Country:US
Practice Address - Phone:785-463-3333
Practice Address - Fax:785-463-3343
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79591-032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily