Provider Demographics
NPI:1114970837
Name:BUCK-ROLLAND, CAROL L (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:BUCK-ROLLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 VILLAGE WOODS
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-6043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1556
Practice Address - Country:US
Practice Address - Phone:802-244-5651
Practice Address - Fax:802-244-5163
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010015366363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4000011Medicaid
VTS65991Medicare UPIN
VT4000011Medicaid