Healthcare Provider Details

I. General information

NPI: 1194608562
Provider Name (Legal Business Name): LYNETTE LUBAY ROLDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

3208 PORTER ST NW
WASHINGTON DC
20008-3211
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6100
  • Fax: 202-644-7024
Mailing address:
  • Phone: 202-536-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number978961
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500025208
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: