Healthcare Provider Details

I. General information

NPI: 1376775452
Provider Name (Legal Business Name): RUTH BARBARA ROESCHLAU R.N.,P.H.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36977 PARK AVE
BURNEY CA
96013-4067
US

IV. Provider business mailing address

PO BOX 27
CASSEL CA
96016-0027
US

V. Phone/Fax

Practice location:
  • Phone: 530-335-3651
  • Fax: 530-335-5241
Mailing address:
  • Phone: 530-335-5882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96824
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number10151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: