Provider Demographics
NPI:1104487677
Name:ROLFE, BRANDILYN (NP)
Entity type:Individual
Prefix:
First Name:BRANDILYN
Middle Name:
Last Name:ROLFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 COTTAGE CT
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-8226
Mailing Address - Country:US
Mailing Address - Phone:404-201-0666
Mailing Address - Fax:
Practice Address - Street 1:2629 COTTAGE CT
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8226
Practice Address - Country:US
Practice Address - Phone:404-201-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTPENDING363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care