Provider Demographics
NPI:1578835229
Name:ANDERSON, ROSLAND ANNETTE
Entity Type:Individual
Prefix:
First Name:ROSLAND
Middle Name:ANNETTE
Last Name:ANDERSON
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 1:6914 WEST APPLETON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2732
Mailing Address - Country:US
Mailing Address - Phone:414-290-7597
Mailing Address - Fax:414-434-2627
Practice Address - Street 1:6914 WEST APPLETON AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2732
Practice Address - Country:US
Practice Address - Phone:414-290-7597
Practice Address - Fax:414-434-2627
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821423187OtherEDUCATION AND TRAINING CENTER