Healthcare Provider Details

I. General information

NPI: 1285681619
Provider Name (Legal Business Name): MARYBETH VAN ROEKEL A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
LOGAN KS
67646-9764
US

IV. Provider business mailing address

1719 HIGHWAY 183 P.O. BOX 547
PHILLIPSBURG KS
67661-2549
US

V. Phone/Fax

Practice location:
  • Phone: 785-689-4220
  • Fax: 785-689-4219
Mailing address:
  • Phone: 785-543-5211
  • Fax: 785-543-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44437
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: