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General NPI Number Information
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NPI Number | 1891027173
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Entity Type | Individual
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Provider Name | MRS. RUTH ALMA ROEDER
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Gender | Female
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN 3RD FLOOR MAIN BLDG CHILDREN'S HOSPITAL OF MI
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-5906
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Fax | 313-745-0955
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Provider Business Mailing Address
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Address Line | 4201 ST. ANTOINE UHC 6F MAILBOX# 226 UNIVERSITY PEDIATRICIANS
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-966-5051
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Fax | 313-966-6618
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704128683
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4704128683
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License Number State | MI
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