Healthcare Provider Details

I. General information

NPI: 1851109086
Provider Name (Legal Business Name): MRS. ROOSEVE LYNN FRUCHTL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ROOSEVE LYNN ARENDS

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 CARLETON AVE
GRAND ISLAND NE
68803-1221
US

IV. Provider business mailing address

2536 CARLETON AVE
GRAND ISLAND NE
68803-1221
US

V. Phone/Fax

Practice location:
  • Phone: 308-385-5775
  • Fax: 308-385-5780
Mailing address:
  • Phone: 308-385-5775
  • Fax: 308-385-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: