Healthcare Provider Details

I. General information

NPI: 1225187834
Provider Name (Legal Business Name): WARREN W ROESCH RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SEVERN AVE OMEGA HOSPITAL
METAIRIE LA
70002-5932
US

IV. Provider business mailing address

230 AUDUBON DR
MANDEVILLE LA
70471
US

V. Phone/Fax

Practice location:
  • Phone: 504-832-4200
  • Fax:
Mailing address:
  • Phone: 985-845-1501
  • Fax: 985-845-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN050984
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: