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SANDRA K ROOF NP

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1043237910

Individual Registrant:
 SANDRA K ROOF NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
111 ANNA ST  WATERLOO, WI 53594-1184 US
Tel: 920-478-3776  Fax: 920-478-3979

Contact information for business:
123 HOSPITAL DR STE 206 WATERTOWN, WI 53098-3320 US
Tel: 920-262-4698  Fax: 920-262-4591

Registration Information:
NPI: 1043237910
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
WI733-033

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1043237910WI05
43868300WI05




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