Healthcare Provider Details

I. General information

NPI: 1144501107
Provider Name (Legal Business Name): ROLANDA B COVERSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 E LANCASTER AVE
PAOLI PA
19301-1550
US

IV. Provider business mailing address

400 S UNION AVE
YEADON PA
19050-2922
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 267-241-0843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011559
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: