Provider Demographics
NPI:1265724165
Name:ROLSTON, HAZEL VERONICA (RN)
Entity type:Individual
Prefix:MS
First Name:HAZEL
Middle Name:VERONICA
Last Name:ROLSTON
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 1:1004 CRAMER CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1218
Mailing Address - Country:US
Mailing Address - Phone:516-850-8896
Mailing Address - Fax:
Practice Address - Street 1:550 FRONT ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4445
Practice Address - Country:US
Practice Address - Phone:516-217-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse