Healthcare Provider Details

I. General information

NPI: 1689164154
Provider Name (Legal Business Name): BONNIE LOUISE ROILL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

IV. Provider business mailing address

19700 N 76TH ST APT 1142
SCOTTSDALE AZ
85255-4799
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-5500
  • Fax:
Mailing address:
  • Phone: 480-922-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: