Provider Demographics
NPI:1861867335
Name:ROSKAM, LOUISANNE
Entity type:Individual
Prefix:
First Name:LOUISANNE
Middle Name:
Last Name:ROSKAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1462
Mailing Address - Country:US
Mailing Address - Phone:816-830-7816
Mailing Address - Fax:
Practice Address - Street 1:2701 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1516
Practice Address - Country:US
Practice Address - Phone:816-384-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009034506164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse