Healthcare Provider Details

I. General information

NPI: 1356264196
Provider Name (Legal Business Name): JASMINE L ROLLAND
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

7000 N 60TH ST APT 201
MILWAUKEE WI
53223-5111
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8710
  • Fax: 414-805-1101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18827-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: