Provider Demographics
NPI:1043083710
Name:ROALSVIG, MARIS
Entity type:Individual
Prefix:
First Name:MARIS
Middle Name:
Last Name:ROALSVIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 LOCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-1114
Mailing Address - Country:US
Mailing Address - Phone:716-297-1478
Mailing Address - Fax:
Practice Address - Street 1:9812 LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-1114
Practice Address - Country:US
Practice Address - Phone:716-297-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1762876231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist