MEDICARE: MS. NANCY A ROE NP

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	363L00000X	Nurse Practitioner	453123	NY
2	363LA2200X	Adult Health Nurse Practitioner	A03703	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861475204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY A ROE NP

Provider Business Mailing Address
First Line	:	540 CONSERVANCY WAY APT 106
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23323-1334
Country	:	US
Telephone Number	:	669-411-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	6477 COLLEGE PARK SQ STE 312
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-3611
Country	:	US
Telephone Number	:	757-452-6932
Fax Number	:	757-905-4316

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/13/2024

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