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NPI Code Detail

MEDICARE: MS. TRACY M ROESCH

MEDICARE: MS. TRACY M ROESCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian64-029WI

General Provider Information

NPI Number : 1033117569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY M ROESCH
Provider Business Mailing Address
First Line : 507 S MONROE ST
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2099
Country : US
Telephone Number : 608-723-2143
Fax Number : 608-723-7595
Provider Business Practice Location Address
First Line : 507 S MONROE ST
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2054
Country : US
Telephone Number : 608-723-3262
Fax Number : 605-723-6325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 01/25/2023

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Directions to “ MS. TRACY M ROESCH ” Practice Location

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