=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194608562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNETTE LUBAY ROLDAN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 915 RHODE ISLAND AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20001-4153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-232-6100
-----------------------------------------------------
Fax | 202-644-7024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3208 PORTER ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-3211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-536-6466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 978961
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN500025208
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------