Healthcare Provider Details

I. General information

NPI: 1528889771
Provider Name (Legal Business Name): EMILY K ROESLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY K LITYNSKI

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 LEONARD ST NE
GRAND RAPIDS MI
49525-6934
US

IV. Provider business mailing address

1111 LEFFINGWELL AVE NE
GRAND RAPIDS MI
49525-6406
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7101
  • Fax: 616-464-6170
Mailing address:
  • Phone: 616-459-7101
  • Fax: 616-464-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: