Provider Demographics
NPI:1922638279
Name:ROEDER, EMILY VIOLET (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VIOLET
Last Name:ROEDER
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:VIOLET
Other - Last Name:BLOCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, CPNP-PC
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:PROVIDER ENROLLMENT - RST
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10508363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics