MEDICARE: SHANA CHRISTINE ROETHER FNP-BC

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	363LF0000X	Family Nurse Practitioner	53-79591-032	KS

General Provider Information

NPI Number	:	1912518481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA CHRISTINE ROETHER FNP-BC

Provider Business Mailing Address
First Line	:	103 SMITH STREET
Second Line	:	PO BOX 186
City	:	MILFORD
State	:	KS
Zip	:	66514-4030
Country	:	US
Telephone Number	:	785-761-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 SMITH ST
Second Line	:
City	:	MILFORD
State	:	KS
Zip	:	66514-5049
Country	:	US
Telephone Number	:	785-463-3333
Fax Number	:	785-463-3343

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	06/02/2025

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