MEDICARE: MS. CHRISTINE ROLLE

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	273R00000X	Psychiatric Hospital Unit	738600	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	63WPO808X	OTHER	CA	REGISTERED NURSE

General Provider Information

NPI Number	:	1982092615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ROLLE

Provider Business Mailing Address
First Line	:	4121 CORNELIA WAY
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-4425
Country	:	US
Telephone Number	:	916-914-3095
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 CORNELIA WAY
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-4425
Country	:	US
Telephone Number	:	916-914-3095
Fax Number	:

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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