Individual
LISA M ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC NNP
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 577-5631
Mailing address
3815 HOLLY HILLS BLVD, SAINT LOUIS, MO 63116-3134
(314) 752-4327
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
066591
MO
Other
Enumeration date
05/12/2007
Last updated
07/08/2007
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