1225387657 NPI number — REBECCA ROLOFF RN, FNP-BC

Table of content: REBECCA ROLOFF RN, FNP-BC (NPI 1225387657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225387657 NPI number — REBECCA ROLOFF RN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLOFF
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-BC
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:
1225387657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 MAIN ST FL 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-323-0220
Provider Business Mailing Address Fax Number:
716-323-0293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 ELLICOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-323-2000
Provider Business Practice Location Address Fax Number:
716-323-0293
Provider Enumeration Date:
08/30/2012

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: 363LF0000X , with the licence number:  F337346-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03509208 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com