Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0533067 | KS |
N | 207Q00000X | Family Doctor | 0533067 | KS |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 05-33067 | KS |
NPI | 1770705253 |
---|---|
Provider Name | Heather Leanne Roe |
First Address | Wichita, KS 67208-4209 |
Second Address | Wichita, KS 67208-4209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 02/03/2021 |