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General NPI Number Information
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NPI Number | 1548562903
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Entity Type | Organization
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Legal Business Name | LORI ROEHL
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 3907 SUMMITVIEW AVE
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City | YAKIMA
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State | WA
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Zip | 98902-2716
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Country | US
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Telephone | 509-469-1903
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Fax | 509-469-1905
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Provider Business Mailing Address
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Address Line | PO BOX 8051
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City | YAKIMA
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State | WA
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Zip | 98908-0051
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Country | US
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Telephone | 509-469-1903
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Fax | 509-469-1905
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | MRS. LORI CLAUDETTE ROEHL
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Credential | ARNP
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Telephone | 509-452-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP30000938
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00077942
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License Number State | WA
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