Healthcare Provider Details

I. General information

NPI: 1033814892
Provider Name (Legal Business Name): HALEY C ROLIN BSN, RN, CDCES, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

IV. Provider business mailing address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-9136
  • Fax: 251-368-0831
Mailing address:
  • Phone: 251-368-9136
  • Fax: 251-368-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1-179309
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: