Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A03568 | AR |
NPI | 1003197542 |
---|---|
Provider Name | Mashae D. Rolland |
First Address | Trumann, AR 72472-1635 |
Second Address | Trumann, AR 72472 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2011 |
Last Update Date | 18/07/2018 |