Provider Demographics
NPI:1902670029
Name:NEISWONGER, ROXANNE
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:NEISWONGER
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 1:9100 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-7926
Mailing Address - Country:US
Mailing Address - Phone:440-813-2519
Mailing Address - Fax:
Practice Address - Street 1:2141 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4604
Practice Address - Country:US
Practice Address - Phone:717-617-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131946164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse