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NPI Code Detail

MEDICARE: KRISTINA RENEE ROESCH CNP

MEDICARE: KRISTINA RENEE ROESCH CNP
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
1363L00000XNurse PractitionerAPRN.CNP.026284OH

General Provider Information

NPI Number : 1871884494
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA RENEE ROESCH CNP
Provider Business Mailing Address
First Line : 346 N AMBOY RD
Second Line :
City : CONNEAUT
State : OH
Zip : 44030-3094
Country : US
Telephone Number : 440-994-9471
Fax Number :
Provider Business Practice Location Address
First Line : 158 W MAIN RD
Second Line :
City : CONNEAUT
State : OH
Zip : 44030-2039
Country : US
Telephone Number : 440-593-0220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2011
Last Update Date : 03/18/2020

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