Healthcare Provider Details

I. General information

NPI: 1528979739
Provider Name (Legal Business Name): DEKEITA ROLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 BEAVERWOOD LN
SILVER SPRING MD
20906-3062
US

IV. Provider business mailing address

3155 BEAVERWOOD LN
SILVER SPRING MD
20906-3062
US

V. Phone/Fax

Practice location:
  • Phone: 301-919-0118
  • Fax:
Mailing address:
  • Phone: 301-919-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR159591
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: