Provider Demographics
NPI:1194143537
Name:ROLLER, ADAM (APRN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ROLLER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 KUALA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3900
Mailing Address - Country:US
Mailing Address - Phone:808-456-2273
Mailing Address - Fax:808-456-2274
Practice Address - Street 1:91-1001 KAIMALIE ST STE 201B
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6250
Practice Address - Country:US
Practice Address - Phone:808-762-0026
Practice Address - Fax:808-427-9397
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1711363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health