MEDICARE: UROULE ANNETTE ROLLAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	111072	NE
2	363LF0000X	Family Nurse Practitioner	F334562	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194895904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UROULE ANNETTE ROLLAN NP

Provider Business Mailing Address
First Line	:	7901 BROADWAY
Second Line	:	MANAGED CARE, D1-01
City	:	ELMHURST
State	:	NY
Zip	:	11373-1329
Country	:	US
Telephone Number	:	718-334-1921
Fax Number	:	718-334-3432

Provider Business Practice Location Address
First Line	:	3000 LINCOLN BLVD
Second Line	:
City	:	BEATRICE
State	:	NE
Zip	:	68310-3319
Country	:	US
Telephone Number	:	402-223-6600
Fax Number	:	402-223-8529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	04/02/2010

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