Healthcare Provider Details

I. General information

NPI: 1770155608
Provider Name (Legal Business Name): JULIE ROSE ROARK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5702
US

IV. Provider business mailing address

1000 N OAK AVE
MARSHFIELD WI
54449-5702
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-5161
  • Fax: 715-389-3677
Mailing address:
  • Phone: 715-387-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number149013-32
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: