Provider Demographics
NPI:1386861599
Name:ROLAND, VIRGINIA (NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ROLAND
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 1:900 COOPER AVE
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5182
Mailing Address - Country:US
Mailing Address - Phone:989-497-9395
Mailing Address - Fax:989-583-7173
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 4100
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-497-9395
Practice Address - Fax:989-583-7173
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704166066363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ29089Medicare UPIN