Individual
LISA ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22294 COFFELT RD, SAINT MARY, MO 63673-9225
(573) 535-4538
Mailing address
22294 COFFELT RD, SAINT MARY, MO 63673-9225
(573) 535-4538
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
100656A
MO
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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