Healthcare Provider Details

I. General information

NPI: 1730919242
Provider Name (Legal Business Name): NATALIE BELLE ROH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N DR MARTIN LUTHER KING JR DR
MILWAUKEE WI
53212-2709
US

IV. Provider business mailing address

2555 N DR MARTIN LUTHER KING JR DR
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-372-8080
  • Fax: 414-372-7425
Mailing address:
  • Phone: 414-372-8080
  • Fax: 414-372-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8204
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8204
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: