Provider Demographics
NPI:1710083654
Name:ROLNIK, NANCY ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:ROLNIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LA CASA VIA # 106
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3013
Mailing Address - Country:US
Mailing Address - Phone:925-464-7278
Mailing Address - Fax:925-464-1318
Practice Address - Street 1:108 LA CASA VIA # 106
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3013
Practice Address - Country:US
Practice Address - Phone:925-464-7278
Practice Address - Fax:925-464-1318
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79371207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793710Medicaid
CAA79371OtherMEDICAL LICENSE
CA00A793710Medicaid
CACS525ZMedicare PIN