Provider Demographics
NPI:1902561418
Name:SUDHOFF, ROXANNE (RN, IPC)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:SUDHOFF
Suffix:
Gender:F
Credentials:RN, IPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FIRETOWN RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3401
Mailing Address - Country:US
Mailing Address - Phone:860-658-1018
Mailing Address - Fax:860-658-7250
Practice Address - Street 1:36 FIRETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-3401
Practice Address - Country:US
Practice Address - Phone:860-658-1018
Practice Address - Fax:860-658-7250
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE55520163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control