1972752806 NPI number — JENNIFER LEE ROLLINS M.S., C.G.C.

Table of content: JENNIFER LEE ROLLINS M.S., C.G.C. (NPI 1972752806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972752806 NPI number — JENNIFER LEE ROLLINS M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLLINS
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., C.G.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972752806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 UNIVERSITY BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-747-8234
Provider Business Mailing Address Fax Number:
409-772-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 UNIVERSITY BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-0587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-747-8234
Provider Business Practice Location Address Fax Number:
409-772-0565
Provider Enumeration Date:
09/16/2008

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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