Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 817178 | TX |
NPI | 1033455100 |
---|---|
Provider Name | Miss Andrea Roldan |
First Address | Mesquite, TX 75150-2664 |
Second Address | Mesquite, TX 75150-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2012 |
Last Update Date | 18/12/2012 |