Provider Demographics
NPI:1033356688
Name:ROLLINS, HEATHER MARIE (RN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:MARIE
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12568 DUTCH CROSS RD
Mailing Address - Street 2:
Mailing Address - City:CROTON
Mailing Address - State:OH
Mailing Address - Zip Code:43013-9795
Mailing Address - Country:US
Mailing Address - Phone:614-562-1068
Mailing Address - Fax:
Practice Address - Street 1:12568 DUTCH CROSS RD
Practice Address - Street 2:
Practice Address - City:CROTON
Practice Address - State:OH
Practice Address - Zip Code:43013-9795
Practice Address - Country:US
Practice Address - Phone:614-562-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120321164W00000X
OHRN367776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2885963Medicaid