Individual
SUSAN C ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
410 GLENN AVE, SUITE 200, BLOOMSBURG, PA 17815-1200
(570) 784-1723
(570) 784-8512
Mailing address
410 GLENN AVE, SUITE 200, BLOOMSBURG, PA 17815-1200
(570) 784-1723
(570) 784-8512
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN240439L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746682 0006
—
PA
05
—
101087458 0002
—
PA
Enumeration date
11/12/2007
Last updated
11/14/2007
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