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General NPI Number Information
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NPI Number | 1851437933
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Entity Type | Individual
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Provider Name | MRS. UNDRAY LOWERY ROLLINSON
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1113 E 2ND ST APT G
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4483
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Country | US
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Telephone | 336-723-0175
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Fax | 336-748-0961
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Provider Business Mailing Address
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Address Line | 1113 E 2ND ST APT G
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4483
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Country | US
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Telephone | 336-723-0175
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Fax | 336-748-0961
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 6600546
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License Number State | NC
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