Healthcare Provider Details

I. General information

NPI: 1871361618
Provider Name (Legal Business Name): RENEE E ROESCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD STE 200
SAINT CHARLES MO
63304-8788
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-5810
  • Fax:
Mailing address:
  • Phone: 557-203-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023046579
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2023046579
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: