Healthcare Provider Details

I. General information

NPI: 1467541219
Provider Name (Legal Business Name): DEBRA LYNN ROLLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

167 ELLINGTON RD
DAYTON OH
45431-1936
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-3975
Mailing address:
  • Phone: 937-781-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN 222935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: