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General NPI Number Information
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NPI Number | 1629585112
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Entity Type | Individual
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Provider Name | RICKI LEE ROELANT FNP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 3404 W SYLVANIA AVE
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City | TOLEDO
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State | OH
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Zip | 43623
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Country | US
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Telephone | 419-407-2445
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Fax |
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Provider Business Mailing Address
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Address Line | 11625 GEIGER RD
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City | TEMPERANCE
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State | MI
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Zip | 48182-9618
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Country | US
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Telephone | 419-388-6837
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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 | 4704328103
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.021179
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License Number State | OH
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