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General NPI Number Information
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NPI Number | 1053886788
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Entity Type | Individual
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Provider Name | MONICA MICHELE ROADRUCK NP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 3218 DAUGHERTY DR STE 140
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City | LAFAYETTE
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State | IN
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Zip | 47909-3997
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Country | US
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Telephone | 765-502-4190
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Fax | 765-502-4191
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Provider Business Mailing Address
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Address Line | 760 PARK EAST BLVD
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City | LAFAYETTE
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State | IN
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Zip | 47905-0795
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Country | US
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Telephone | 765-447-7473
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Fax | 765-449-8504
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 71008438A
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License Number State | IN
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