Provider Demographics
NPI:1174068498
Name:ROEHM, EMILY ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:ROEHM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:PIONTKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:28203 JOAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1451
Mailing Address - Country:US
Mailing Address - Phone:586-925-1726
Mailing Address - Fax:
Practice Address - Street 1:882 OAKMAN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3710
Practice Address - Country:US
Practice Address - Phone:313-961-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse