Provider Demographics
NPI:1861964488
Name:SLICE, ROGER BECK (RN BSN)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:BECK
Last Name:SLICE
Suffix:
Gender:M
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019
Mailing Address - Country:US
Mailing Address - Phone:602-336-2990
Mailing Address - Fax:602-336-2271
Practice Address - Street 1:6331 N. 39TH AVE.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019
Practice Address - Country:US
Practice Address - Phone:602-841-7445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN181505163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse