Individual
MS. RENEE L ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
8881 N MAIN ST, DAYTON, OH 45415-1333
(937) 293-1622
(937) 245-6308
Mailing address
6680 POE AVE STE 200, DAYTON, OH 45414-2855
(937) 280-8400
(937) 280-8373
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN.CNP.10617
OH
364SA2100X
Acute Care Clinical Nurse Specialist
COA10617NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000611757
ANTHEM
OH
05
—
2983802
—
OH
Enumeration date
03/03/2009
Last updated
11/29/2022
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