Individual
HEATHER A ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2500 DELL RANGE BLVD, CHEYENNE, WY 82009-5273
(307) 630-4729
Mailing address
PO BOX 20092, CHEYENNE, WY 82003-7002
(307) 630-4729
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
057094-21
NH
363L00000X
Nurse Practitioner
057094-23-03
NH
363L00000X
Nurse Practitioner
0990361
CO
363L00000X
Nurse Practitioner
259049
MA
363L00000X
Nurse Practitioner
Primary
52020
WY
Other
Enumeration date
01/15/2007
Last updated
04/15/2024
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