Individual
THERESA L ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2717
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2717
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
28112127A
IN
Other
Enumeration date
12/12/2006
Last updated
07/08/2007
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