1699782730 NPI number — GAYNELLE V. ROLLING DO

Table of content: GAYNELLE V. ROLLING DO (NPI 1699782730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699782730 NPI number — GAYNELLE V. ROLLING DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLING
Provider First Name:
GAYNELLE
Provider Middle Name:
V.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699782730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
653 N TOWN CENTER DR
Provider Second Line Business Mailing Address:
#602
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89144-0514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-255-3547
Provider Business Mailing Address Fax Number:
702-255-3549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
653 N TOWN CENTER DR
Provider Second Line Business Practice Location Address:
#602
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89144-0514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-255-3547
Provider Business Practice Location Address Fax Number:
702-255-3549
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  1116 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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