Provider Demographics
NPI:1982253969
Name:ROESTEL, CAROLINE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:ROESTEL
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 1:342 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3512
Mailing Address - Country:US
Mailing Address - Phone:617-416-6410
Mailing Address - Fax:
Practice Address - Street 1:342 LAGOON DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3512
Practice Address - Country:US
Practice Address - Phone:617-416-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.476053163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse