Provider Demographics
NPI:1427150218
Name:ROETH, MAUREEN A (FNP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:ROETH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9758
Mailing Address - Country:US
Mailing Address - Phone:518-439-8498
Mailing Address - Fax:
Practice Address - Street 1:3 MERCYCARE LN
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084-3504
Practice Address - Country:US
Practice Address - Phone:518-452-6760
Practice Address - Fax:518-452-6756
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332985-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily