Provider Demographics
NPI:1174708234
Name:ROESCH, TRICIA L (CRNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:ROESCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:L
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 CATON AVE
Mailing Address - Street 2:MAILBOX 207
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:410-368-2730
Mailing Address - Fax:410-400-6967
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:MAILBOX 207
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2730
Practice Address - Fax:410-400-6967
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner