Provider Demographics
NPI:1477111037
Name:ROLADER, BRANDIE (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:
Last Name:ROLADER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 LAUREL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-2657
Mailing Address - Country:US
Mailing Address - Phone:770-653-8802
Mailing Address - Fax:
Practice Address - Street 1:1414 DUG GAP RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5007
Practice Address - Country:US
Practice Address - Phone:706-279-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA077919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse