Individual
MRS. SHOSTY SUE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2215 S 6TH ST, BRAINERD, MN 56401-5512
(218) 454-1010
Mailing address
2215 S 6TH ST, BRAINERD, MN 56401-5512
(218) 454-1010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10742
MN
Other
Enumeration date
01/29/2010
Last updated
11/05/2025
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