Healthcare Provider Details

I. General information

NPI: 1891120846
Provider Name (Legal Business Name): ROBYN C ROELL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN M CARLI P.A.

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BARAGA AVE STE 20
MARQUETTE MI
49855-4550
US

IV. Provider business mailing address

PO BOX 13811
BELFAST ME
04915-4029
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-3440
  • Fax:
Mailing address:
  • Phone: 906-225-3630
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006783
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: