Provider Demographics
NPI:1992045801
Name:REEDER, ROLANDA ANN (RN)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:ANN
Last Name:REEDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 LINDEN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3045
Mailing Address - Country:US
Mailing Address - Phone:937-516-3998
Mailing Address - Fax:
Practice Address - Street 1:2710 LINDEN AVE STE F
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3045
Practice Address - Country:US
Practice Address - Phone:937-516-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH143168164W00000X
OH519664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse