Individual
TINA L ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2321 E HIGHLAND AVE # 3135, PHOENIX, AZ 85016-5266
(208) 353-4209
Mailing address
2321 E HIGHLAND AVE # 3135, PHOENIX, AZ 85016-5266
(208) 353-4209
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP046575
AZ
Other
Enumeration date
07/26/2010
Last updated
07/26/2010
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