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NPI Code Detail

MEDICARE: ASHLEY ROULETTE CCHW, PPSS, LTA

MEDICARE: ASHLEY ROULETTE CCHW, PPSS, LTA
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
1172V00000XCommunity Health Worker49425ND

General Provider Information

NPI Number : 1740132174
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY ROULETTE CCHW, PPSS, LTA
Provider Business Mailing Address
First Line : 405 PITCHER PARK SE # 405
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-3998
Country : US
Telephone Number : 701-662-9698
Fax Number :
Provider Business Practice Location Address
First Line : 1031 7TH ST NE
Second Line :
City : DEVILS LAKE
State : ND
Zip : 58301-2719
Country : US
Telephone Number : 701-662-9698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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Directions to “ ASHLEY ROULETTE CCHW, PPSS, LTA” Practice Location

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