Provider Demographics
NPI:1669037206
Name:ROLANDELLI, AUDREY LEE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEE
Last Name:ROLANDELLI
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 1:7 S MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-1311
Mailing Address - Country:US
Mailing Address - Phone:763-238-1083
Mailing Address - Fax:
Practice Address - Street 1:2081 CALISTOGA DR STE 2S
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-4833
Practice Address - Country:US
Practice Address - Phone:763-238-1083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019381363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health