Provider Demographics
NPI:1003197542
Name:ROLLAND, MASHAE D (APRN)
Entity Type:Individual
Prefix:
First Name:MASHAE
Middle Name:D
Last Name:ROLLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HIGHWAY 463 N
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-1635
Mailing Address - Country:US
Mailing Address - Phone:870-483-7631
Mailing Address - Fax:870-483-7659
Practice Address - Street 1:808 HIGHWAY 463 N
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472
Practice Address - Country:US
Practice Address - Phone:870-483-7631
Practice Address - Fax:870-483-7659
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner