Doctor Name: | MS. MARY SUSAN ROACH |
NPI Number: | 1437281375 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | NP 87-A |
Business Practice Address: | 703 N. 1st Street Mccall, ID - 836383851 |
Business Phone Number: | 2086308002 |
Business Fax Number: | 2086342174 |
Mailing Address: | Po Box 470, MCCALL |
State: | ID |
Postal Code: | 836380470 |
Phone Number: | 2086342174 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NP 87-A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |