Provider Demographics
NPI:1063588853
Name:ROLLER, MAUREEN C (DNP, ANP-C (ANP-BC))
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:C
Last Name:ROLLER
Suffix:
Gender:F
Credentials:DNP, ANP-C (ANP-BC)
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:C
Other - Last Name:ROLLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ANP-BC
Mailing Address - Street 1:206 GLEN COVE AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579
Mailing Address - Country:US
Mailing Address - Phone:516-676-1742
Mailing Address - Fax:516-676-9662
Practice Address - Street 1:206 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579
Practice Address - Country:US
Practice Address - Phone:516-676-1742
Practice Address - Fax:516-676-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303280363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2E4683Medicare ID - Type Unspecified
NY234683Medicare UPIN
P59722Medicare UPIN