Organization
CROSSROADS HEALTH & COSMETIC CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNA ROTH ACNP-BC, FNP-C (NURSE PRACTITIONER)
(574) 891-4920
Entity
Organization
Contact information
Practice address
21764 OMEGA CT, GOSHEN, IN 46528-7809
(574) 891-4920
(574) 891-4902
Mailing address
21764 OMEGA CT, GOSHEN, IN 46528-7809
(574) 891-4920
(574) 891-4902
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002933A
IN
363LA2100X
Acute Care Nurse Practitioner
71002933A
IN
363LP2300X
Primary Care Nurse Practitioner
71002933A
IN
Other
Enumeration date
11/07/2015
Last updated
09/09/2019
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