Provider Demographics
NPI:1801557319
Name:ROLDAN, CLAUDIA A (FNP)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:A
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 N WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-0724
Mailing Address - Country:US
Mailing Address - Phone:773-443-5156
Mailing Address - Fax:
Practice Address - Street 1:2550 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-4661
Practice Address - Country:US
Practice Address - Phone:708-575-6757
Practice Address - Fax:877-653-2695
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041400346163WC0200X
IL209024752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041400436OtherIDFPR
IL209024752OtherIDFPR