Individual
COLLEEN BRYNNE ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7000
Mailing address
601 CHILDRENS LN, NORFOLK, VA 23507-1971
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9434989
FL
363LN0000X
Neonatal Nurse Practitioner
0024180335
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
01/23/2019
Last updated
10/14/2020
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