Provider Demographics
NPI:1003065244
Name:ROLLINS, BRANDI LEA (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEA
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 KILBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5318
Mailing Address - Country:US
Mailing Address - Phone:614-216-1012
Mailing Address - Fax:
Practice Address - Street 1:2288 KILBOURNE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5318
Practice Address - Country:US
Practice Address - Phone:614-216-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.104318-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse