Individual
MS. MARY SUSAN ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
703 N. 1ST STREET, MCCALL, ID 83638-3851
(208) 630-8002
(208) 634-2174
Mailing address
PO BOX 470, MCCALL, ID 83638-0470
(208) 634-2174
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP 87-A
ID
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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