Basic Information
| Provider Information | |||||||||
| NPI: | 1639165962 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADICH | ||||||||
| FirstName: | ROXANNE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7543 SUNBURST LN | ||||||||
| Address2: | |||||||||
| City: | NEENAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549569016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208512458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3916 N INTERTECH CT | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549136957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9209961000 | ||||||||
| FaxNumber: | 9209961050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2351-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.