Provider Demographics
NPI:1164102117
Name:ROLL, VANESSA (RN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ROLL
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 1:10669 TIMBERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-8423
Mailing Address - Country:US
Mailing Address - Phone:812-701-0297
Mailing Address - Fax:
Practice Address - Street 1:10669 TIMBERVIEW RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-8423
Practice Address - Country:US
Practice Address - Phone:812-701-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28172068A163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology