Individual
STEPHANY ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4012 LAHMEYER RD, FORT WAYNE, IN 46815-5622
(260) 908-0465
Mailing address
4012 LAHMEYER RD, FORT WAYNE, IN 46815-5622
(260) 908-0465
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28234536A
IN
Other
Enumeration date
04/23/2018
Last updated
04/23/2018
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