Provider Demographics
NPI:1508365792
Name:ROLAND, BRYAN TERELL JR
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:TERELL
Last Name:ROLAND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 PASSIONATE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3538
Mailing Address - Country:US
Mailing Address - Phone:702-351-6391
Mailing Address - Fax:
Practice Address - Street 1:4017 FABULOUS FINCHES AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-4808
Practice Address - Country:US
Practice Address - Phone:702-384-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14045300813747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant