Provider Demographics
NPI:1477292639
Name:ROLEY, GWEN
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:ROLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VINTAGE WALK
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2101
Mailing Address - Country:US
Mailing Address - Phone:513-460-6038
Mailing Address - Fax:
Practice Address - Street 1:26 VINTAGE WALK
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-2101
Practice Address - Country:US
Practice Address - Phone:513-460-6038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide