Provider Demographics
NPI:1568159242
Name:ROLLASON, SANDRA ANGELA
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANGELA
Last Name:ROLLASON
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 1:1050 NEWCASTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1895
Mailing Address - Country:US
Mailing Address - Phone:541-973-8580
Mailing Address - Fax:
Practice Address - Street 1:1050 NEWCASTLE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1895
Practice Address - Country:US
Practice Address - Phone:541-973-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider