Healthcare Provider Details

I. General information

NPI: 1740445071
Provider Name (Legal Business Name): ANNETTE M ROLLE CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ANNETTE MARY ROLLE

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12915 KNOTTY GLEN LN
HOUSTON TX
77072-3119
US

IV. Provider business mailing address

12915 KNOTTY GLEN LN
HOUSTON TX
77072-3119
US

V. Phone/Fax

Practice location:
  • Phone: 832-888-7005
  • Fax: 281-568-0400
Mailing address:
  • Phone: 832-888-7005
  • Fax: 281-568-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA08152727
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: