Provider Demographics
NPI:1598739351
Name:ROLATER, SONDRA G (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:G
Last Name:ROLATER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 COUNTY ROAD 4555
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75494
Mailing Address - Country:US
Mailing Address - Phone:903-452-8638
Mailing Address - Fax:903-629-3007
Practice Address - Street 1:2904 N. 4TH SUITE
Practice Address - Street 2:SUITE 101A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-452-8638
Practice Address - Fax:903-452-8638
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44699Medicare UPIN
TXTXB147873Medicare PIN