Provider Demographics
NPI:1972088524
Name:ROLLON, MAI-LIN (CNM)
Entity Type:Individual
Prefix:
First Name:MAI-LIN
Middle Name:
Last Name:ROLLON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MAI-LIN
Other - Middle Name:DENEEN
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 S VAL VISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7309
Mailing Address - Country:US
Mailing Address - Phone:480-782-0993
Mailing Address - Fax:855-329-8939
Practice Address - Street 1:3815 S VAL VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7309
Practice Address - Country:US
Practice Address - Phone:480-782-0993
Practice Address - Fax:855-329-8939
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ217854367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMR5016058OtherDEA