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General NPI Number Information
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NPI Number | 1699407874
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Entity Type | Individual
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Provider Name | MARIA ROCHE
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 4465 S 48TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-3618
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Country | US
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Telephone | 414-750-7645
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 S 51ST ST APT 5
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City | MILWAUKEE
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State | WI
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Zip | 53220-3230
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Country | US
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Telephone | 414-708-7833
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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