Roebuckderm LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4301065408 Issued in MI

Legal business name

ROEBUCKDERM LLC

Practice address

5807 W Maple Rd Ste 171
West Bloomfield, MI 48322-4483

Phone

(248) 932-2607

NPI assigned

Dec 29, 2014

Organization subpart

No

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

Authorized official

Name

Heather Roebuck, NP

Title

President

Phone

(248) 932-2607

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1419811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1750779708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5807 W MAPLE RD STE 171",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224483",
            "telephone_number": "248-932-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5807 W MAPLE RD STE 171",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224483",
            "telephone_number": "248-932-2607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROEBUCKDERM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-29",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "ROEBUCK",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-932-2607",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4301065408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Leigh Roda, OTR/L
• Erin Rodes, OTRL
• Michelle Ann Rodgard
• Rose Anesta Rodnez-Simpson, LMSW
• Heather Roebuck, DNP
• Arthur Edward Roffey, PH.D.
• Stephanie Rogers, LMSW
• Suzanne Rogers, LMSW
• Brigid Isabel Rojas
• Logan Roland

• Nurse Practitioner in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.