Provider Demographics
NPI:1003058702
Name:ROLLASON, THERESA MARIE (NURSING-MSN)
Entity Type:Individual
Prefix:MR
First Name:THERESA
Middle Name:MARIE
Last Name:ROLLASON
Suffix:
Gender:F
Credentials:NURSING-MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 15244 BOX 425
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:8227-917-5515
Mailing Address - Fax:
Practice Address - Street 1:UNIT 15244 BOX 425
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-5244
Practice Address - Country:US
Practice Address - Phone:8227-917-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5934237163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine