Healthcare Provider Details

I. General information

NPI: 1710970819
Provider Name (Legal Business Name): NANCY LYNN ROLLINSON APRN, C-PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST LCI 302 BOX 8064
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

79 WEST ST
SHELTON CT
06484-2217
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-4396
  • Fax: 203-737-2786
Mailing address:
  • Phone: 203-924-0302
  • Fax: 203-737-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number003174
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: