MEDICARE: LOUISANNE ROSKAM

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	164W00000X	Licensed Practical Nurse	2009034506	MO

General Provider Information

NPI Number	:	1861867335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISANNE ROSKAM

Provider Business Mailing Address
First Line	:	8110 E 81ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-1462
Country	:	US
Telephone Number	:	816-830-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 E 31ST ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1516
Country	:	US
Telephone Number	:	816-384-0700
Fax Number	:

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

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	12/09/2015

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Directions to “ LOUISANNE ROSKAM ” Practice Location

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