Provider Demographics
NPI:1598346884
Name:ROLDAN, RACHEL DAWN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DAWN
Other - Last Name:FITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2429
Mailing Address - Country:US
Mailing Address - Phone:641-751-0699
Mailing Address - Fax:
Practice Address - Street 1:403 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2429
Practice Address - Country:US
Practice Address - Phone:641-751-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJMH00001922641Medicaid