Colleen Marie Roethke, RN

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

R 103484-2 Issued in MN

Practice address

1455 Saint Francis Ave
Diabetes Education Program
Shakopee, MN 55379-3374

Phone

(952) 403-2609

Fax

(952) 403-3806

NPI assigned

Feb 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1225172505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13908 JAMES AVE S",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374456",
            "telephone_number": "952-403-2609",
            "fax_number": "952-403-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 SAINT FRANCIS AVE",
            "address_2": "DIABETES EDUCATION PROGRAM",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553793374",
            "telephone_number": "952-403-2609",
            "fax_number": "952-403-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROETHKE",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MN",
            "license": "R 103484-2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Manuel Roman, MD
• Ronald S Mash PA (shakopee chiropractic center)
• Elizabeth Ann Root
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• Amanda Kathryn Ross, PA-C

• Diabetes Educator Registered Nurse in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Diabetes Educator Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.