Doctor Name: | DIANE E ROELL |
NPI Number: | 1164464665 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CFNP |
License Number: | 4704138061 |
Business Practice Address: | 715 Pyle Dr Kingsford, MI - 498024456 |
Business Phone Number: | 9067740522 |
Business Fax Number: | 9067791306 |
Mailing Address: | 715 Pyle Dr, KINGSFORD |
State: | MI |
Postal Code: | 498024456 |
Phone Number: | 9067740522 |
Fax Number: | 9067791306 |
NPI Enumeration Date: | 06/11/2006 |
NPI Last Update Date: | 09/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | 4704138061 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |