Healthcare Provider Details

I. General information

NPI: 1891054011
Provider Name (Legal Business Name): ROXANNE KASSELMANN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNE VENZUCH

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CAPITOL AVE # MS 4502
SACRAMENTO CA
95814-5005
US

IV. Provider business mailing address

3300 PARKSIDE DR APT 2
ROCKLIN CA
95677-2540
US

V. Phone/Fax

Practice location:
  • Phone: 916-558-1805
  • Fax:
Mailing address:
  • Phone: 406-461-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number573562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: