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NPI Code Detail

MEDICARE: MRS. KRISTIN MARIE ROELFS MPAS, PA-C

MEDICARE: MRS. KRISTIN MARIE ROELFS MPAS, PA-C
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
1363A00000XPhysician Assistant1564NE

General Provider Information

NPI Number : 1841596681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN MARIE ROELFS MPAS, PA-C
Provider Business Mailing Address
First Line : 501 N ALLEN AVE
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-1411
Country : US
Telephone Number : 402-305-6478
Fax Number :
Provider Business Practice Location Address
First Line : 210 MCNEEL LN
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-6290
Country : US
Telephone Number : 308-534-9230
Fax Number : 308-534-5016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2011
Last Update Date : 01/26/2011

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