Doctor Name: | SONJA M. ROACH |
NPI Number: | 1396770772 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | R 147424-0 |
Business Practice Address: | 4570 County Highway 61 Moose Lake, MN - 55767 |
Business Phone Number: | 2184854491 |
Business Fax Number: | 2184854724 |
Mailing Address: | 4570 County Highway 61, MOOSE LAKE |
State: | MN |
Postal Code: | 55767 |
Phone Number: | 2184854491 |
Fax Number: | 2184854724 |
NPI Enumeration Date: | 07/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R 147424-0 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |