MEDICARE: KAREN S. ROTH ANP-BC, ACHPN

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
1	363LA2200X	Adult Health Nurse Practitioner	F300625	NY

General Provider Information

NPI Number	:	1093714784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN S. ROTH ANP-BC, ACHPN

Provider Business Mailing Address
First Line	:	4195 W WALWORTH RD
Second Line	:
City	:	MACEDON
State	:	NY
Zip	:	14502-9313
Country	:	US
Telephone Number	:	315-986-5771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 DRIVING PARK AVE
Second Line	:
City	:	NEWARK
State	:	NY
Zip	:	14513-1057
Country	:	US
Telephone Number	:	315-359-2640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	03/26/2009

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