Healthcare Provider Details

I. General information

NPI: 1134037054
Provider Name (Legal Business Name): WENDY ROFF LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 STATE ROUTE 20
SEDRO WOOLLEY WA
98284-4322
US

IV. Provider business mailing address

46433 E MAIN ST
CONCRETE WA
98237-9437
US

V. Phone/Fax

Practice location:
  • Phone: 360-854-7400
  • Fax:
Mailing address:
  • Phone: 360-854-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLPN.LP.61092631
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: