Provider Demographics
NPI:1942824552
Name:ROLLER, DENI NICOLE
Entity Type:Individual
Prefix:
First Name:DENI
Middle Name:NICOLE
Last Name:ROLLER
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 1:544 ROYALTON DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2658
Mailing Address - Country:US
Mailing Address - Phone:850-867-8944
Mailing Address - Fax:
Practice Address - Street 1:544 ROYALTON DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2658
Practice Address - Country:US
Practice Address - Phone:850-867-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer