Provider Demographics
NPI:1508295403
Name:ROLAND, CHANDRA
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:
Last Name:ROLAND
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 1:1201 ELY ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1336
Mailing Address - Country:US
Mailing Address - Phone:573-888-5925
Mailing Address - Fax:573-717-7059
Practice Address - Street 1:1201 ELY ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-5925
Practice Address - Fax:573-717-7059
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other