Healthcare Provider Details

I. General information

NPI: 1578835229
Provider Name (Legal Business Name): ROSLAND ANNETTE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6914 WEST APPLETON AVENUE
MILWAUKEE WI
53216-2732
US

IV. Provider business mailing address

6914 WEST APPLETON AVENUE
MILWAUKEE WI
53216-2732
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-7597
  • Fax: 414-434-2627
Mailing address:
  • Phone: 414-290-7597
  • Fax: 414-434-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: