Healthcare Provider Details

I. General information

NPI: 1023700507
Provider Name (Legal Business Name): ALYSSA MARGUERITE ROACH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA MARGUERITE ROACH CNM

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD STE 214
LAWRENCEVILLE NJ
08648-2526
US

IV. Provider business mailing address

631 LEVERINGTON AVE APT 108
PHILADELPHIA PA
19128-2608
US

V. Phone/Fax

Practice location:
  • Phone: 484-274-9819
  • Fax:
Mailing address:
  • Phone: 484-274-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: