Healthcare Provider Details

I. General information

NPI: 1619360310
Provider Name (Legal Business Name): SUE YEON ROH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 BOWEN ST
LEANDER TX
78641-4422
US

IV. Provider business mailing address

2416 BOWEN ST
LEANDER TX
78641-4422
US

V. Phone/Fax

Practice location:
  • Phone: 602-960-3627
  • Fax: 602-894-0577
Mailing address:
  • Phone: 602-960-3627
  • Fax: 602-894-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP126383
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number337684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: