Provider Demographics
NPI:1477792281
Name:ROLLING, DEANNA G (PA)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:G
Last Name:ROLLING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:M
Other - Last Name:GILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4721
Mailing Address - Fax:504-842-4721
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4721
Practice Address - Fax:504-842-4721
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200225.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1382779Medicaid
LA1382779Medicaid