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General NPI Number Information
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NPI Number | 1144705054
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Entity Type | Individual
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Provider Name | ANDREA M ROELLE RN
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 513 W UNION ST
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City | NEWARK
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State | NY
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Zip | 14513-1365
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Country | US
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Telephone | 315-573-7577
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 423
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City | PENN YAN
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State | NY
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Zip | 14527-0423
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Country | US
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Telephone | 315-531-9102
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 408641
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License Number State | NY
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