Provider Demographics
NPI:1669033213
Name:WILTZ, ROLANDA (LVN)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:
Last Name:WILTZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 BARKSDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-3504
Mailing Address - Country:US
Mailing Address - Phone:502-489-7125
Mailing Address - Fax:
Practice Address - Street 1:3012 BARKSDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-3504
Practice Address - Country:US
Practice Address - Phone:502-489-7125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2045538164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse