Individual
ROXANNE OMOAHOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
301 GIBSON DR, ROSEVILLE, CA 95678-5400
(607) 592-1611
Mailing address
1212 COLUMBUS ST, PELLA, IA 50219-1443
(607) 592-1611
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
152598
IA
163WH0200X
Home Health Registered Nurse
Primary
152598
IA
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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