Healthcare Provider Details

I. General information

NPI: 1245745231
Provider Name (Legal Business Name): EMMY ROESEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 10/11/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20960 S FRANKFORT SQUARE RD STE C
FRANKFORT IL
60423-5127
US

IV. Provider business mailing address

16738 W NATOMA DR
LOCKPORT IL
60441-6236
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-7100
  • Fax:
Mailing address:
  • Phone: 815-370-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016971
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: