Individual
MEGAN ROETHLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCP, RN
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 355-5636
Mailing address
6308 8TH AVE, KENOSHA, WI 53143-5031
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
196715
WI
242T00000X
Perfusionist
Primary
—
—
Other
Enumeration date
03/14/2017
Last updated
04/05/2019
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