Healthcare Provider Details

I. General information

NPI: 1063650620
Provider Name (Legal Business Name): MARIA JANG ROERING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75TH MED (AS) BOX 57 UNIT# 15190
APO AP
96271-5160
US

IV. Provider business mailing address

BOX 57, 75TH MED (AS) UNIT # 15190
APO AP
96271-5160
US

V. Phone/Fax

Practice location:
  • Phone: 505-763-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145447
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: