Provider Demographics
NPI:1881738615
Name:ROESE, ROXANNE (NURSEPRACTITIONER NP)
Entity type:Individual
Prefix:MISS
First Name:ROXANNE
Middle Name:
Last Name:ROESE
Suffix:
Gender:F
Credentials:NURSEPRACTITIONER NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 S LOOMIS ROAD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185
Mailing Address - Country:US
Mailing Address - Phone:262-895-4824
Mailing Address - Fax:
Practice Address - Street 1:21425B SPRING STREET
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182
Practice Address - Country:US
Practice Address - Phone:262-878-6532
Practice Address - Fax:262-878-6570
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner