Healthcare Provider Details

I. General information

NPI: 1023861762
Provider Name (Legal Business Name): TENA SHIZUMA ROLLMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENA SHIZUMA

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

835 MADISON AVE
CARY NC
27513-4339
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-5551
  • Fax:
Mailing address:
  • Phone: 702-327-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number5020505
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: