Individual
PHYLLIS A ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
100029
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN11006355
FL
367500000X
Certified Registered Nurse Anesthetist
RN286028L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9810009596
—
WV
Enumeration date
12/20/2006
Last updated
02/01/2021
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