Healthcare Provider Details

I. General information

NPI: 1306494380
Provider Name (Legal Business Name): ABBY ANN ROICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E 12TH ST
CASPER WY
82601-4007
US

IV. Provider business mailing address

2020 E 12TH ST
CASPER WY
82601-4007
US

V. Phone/Fax

Practice location:
  • Phone: 307-995-1135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: