Provider Demographics
NPI:1982934758
Name:ROLLINS, RAY A (CRNA)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:A
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:1575 BEAM AVE
Mailing Address - Street 2:ANESTHESIA DEPT
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1126
Mailing Address - Country:US
Mailing Address - Phone:651-735-0501
Mailing Address - Fax:651-735-1870
Practice Address - Street 1:245 RUTH ST N
Practice Address - Street 2:SUITE 202
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4323
Practice Address - Country:US
Practice Address - Phone:651-251-8021
Practice Address - Fax:651-251-8050
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
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Provider Licenses
StateLicense IDTaxonomies
MNR1473649367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered