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General NPI Number Information
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NPI Number | 1245745231
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Entity Type | Individual
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Provider Name | EMMY ROESEL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 20960 S FRANKFORT SQUARE RD STE C
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City | FRANKFORT
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State | IL
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Zip | 60423-5127
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Country | US
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Telephone | 815-469-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 16738 W NATOMA DR
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City | LOCKPORT
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State | IL
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Zip | 60441-6236
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Country | US
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Telephone | 815-370-9533
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.016971
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License Number State | IL
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