| Doctor Name: | MARY LOU ROETHEL |
| NPI Number: | 1083927412 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN,NP-C,APNP |
| License Number: | 4078-33 |
| Business Practice Address: | 1621 N Taylor Dr Suite 300 Sheboygan, WI - 530811990 |
| Business Phone Number: | 9204964700 |
| Business Fax Number: | |
| Mailing Address: | 1621 N Taylor Dr, Suite 300 SHEBOYGAN |
| State: | WI |
| Postal Code: | 530811990 |
| Phone Number: | 9204964700 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2010 |
| NPI Last Update Date: | 12/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4078-33 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |