Provider Demographics
NPI:1710469507
Name:ROLL, EMMA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:ROLL
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 1:3440 TELFORD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1619
Mailing Address - Country:US
Mailing Address - Phone:937-344-0953
Mailing Address - Fax:
Practice Address - Street 1:3440 BUSENBARK RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-7612
Practice Address - Country:US
Practice Address - Phone:513-867-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program