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NPI Code Detail

MEDICARE: ROXANNE DALE RN

MEDICARE: ROXANNE DALE RN
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
1163W00000XRegistered Nurse454654TX

General Provider Information

NPI Number : 1922327857
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROXANNE DALE RN
Provider Business Mailing Address
First Line : 1430 COLLIER ST
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2911
Country : US
Telephone Number : 512-472-4357
Fax Number : 512-703-1394
Provider Business Practice Location Address
First Line : 6222 N LAMAR BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78752-4004
Country : US
Telephone Number : 512-206-4062
Fax Number : 512-380-9758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2010
Last Update Date : 05/17/2010

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