Individual
COLBEY RUSSELL ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 N 89TH ST STE 202, OMAHA, NE 68114-4072
(402) 502-5750
Mailing address
23922 MCPHERSON AVE, COUNCIL BLUFFS, IA 51503-5974
(402) 350-0123
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P67136
IA
Other
Enumeration date
02/19/2025
Last updated
02/19/2025
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