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General NPI Number Information
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NPI Number | 1437847563
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Entity Type | Individual
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Provider Name | ADRIANNE CANDACE ROUGHFACE
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Gender | Female
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 807 SW F AVE
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City | LAWTON
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State | OK
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Zip | 73501-4506
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Country | US
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Telephone | 580-492-3449
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Fax | 580-357-9211
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Provider Business Mailing Address
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Address Line | PO BOX 908
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City | LAWTON
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State | OK
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Zip | 73502-0908
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Country | US
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Telephone | 580-357-3449
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Fax | 580-354-9211
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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 | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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