Healthcare Provider Details

I. General information

NPI: 1699232686
Provider Name (Legal Business Name): SARAH ROEGGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 15TH ST
BEARDSTOWN IL
62618-1774
US

IV. Provider business mailing address

238 S CONGRESS ST
RUSHVILLE IL
62681-1465
US

V. Phone/Fax

Practice location:
  • Phone: 217-323-2245
  • Fax:
Mailing address:
  • Phone: 217-322-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018865
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: