Provider Demographics
NPI:1336518604
Name:ROLAND, LEANNA M (LPN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:M
Last Name:ROLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 STONEY KILL RD
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-3529
Mailing Address - Country:US
Mailing Address - Phone:845-626-4827
Mailing Address - Fax:
Practice Address - Street 1:584 STONEY KILL RD
Practice Address - Street 2:
Practice Address - City:KERHONKSON
Practice Address - State:NY
Practice Address - Zip Code:12446-3529
Practice Address - Country:US
Practice Address - Phone:845-626-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323102164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse