Healthcare Provider Details

I. General information

NPI: 1154282648
Provider Name (Legal Business Name): RACHEL ROEHRIG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

IV. Provider business mailing address

N9287 COUNTY RD W
MALONE WI
53049-1526
US

V. Phone/Fax

Practice location:
  • Phone: 920-743-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17113-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: