MEDICARE: KAREN ROACH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	200342070RN	OR

General Provider Information

NPI Number	:	1306182431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ROACH RN

Provider Business Mailing Address
First Line	:	2860 STATE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8474
Country	:	US
Telephone Number	:	541-776-6222
Fax Number	:	541-776-6215

Provider Business Practice Location Address
First Line	:	2860 STATE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-8474
Country	:	US
Telephone Number	:	541-776-6222
Fax Number	:	541-776-6215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2012
Last Update Date	:	12/18/2012

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