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NPI Code Detail

MEDICARE: ELLEN M ROCHE F.N.P.

MEDICARE: ELLEN M ROCHE F.N.P.
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
1363LF0000XFamily Nurse Practitioner237030CA
2363LF0000XFamily Nurse PractitionerNP793CA

General Provider Information

NPI Number : 1326021320
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN M ROCHE F.N.P.
Provider Business Mailing Address
First Line : 4750 HOEN AVE
Second Line : SUITE B
City : SANTA ROSA
State : CA
Zip : 95405-7824
Country : US
Telephone Number : 707-542-1611
Fax Number : 707-542-9958
Provider Business Practice Location Address
First Line : 4750 HOEN AVE
Second Line : SUITE B
City : SANTA ROSA
State : CA
Zip : 95405-7824
Country : US
Telephone Number : 707-542-1611
Fax Number : 707-542-9958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 02/04/2021

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