Provider Demographics
NPI:1679935407
Name:ROESNER, LEAH ANN
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:ANN
Last Name:ROESNER
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 1:8522 OAKBROOK RDG NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9375
Mailing Address - Country:US
Mailing Address - Phone:616-581-6079
Mailing Address - Fax:
Practice Address - Street 1:8522 OAKBROOK RDG NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9375
Practice Address - Country:US
Practice Address - Phone:616-581-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information