Provider Demographics
NPI:1275764037
Name:ROLAND, EDITH MARIE (LICENSED PRACTICAL)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:MARIE
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 GRAND STREET E.
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-3704
Mailing Address - Country:US
Mailing Address - Phone:516-333-9413
Mailing Address - Fax:
Practice Address - Street 1:272 GRAND STREET E.
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-3704
Practice Address - Country:US
Practice Address - Phone:516-333-9413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse