Provider Demographics
NPI:1194978379
Name:ROLDAN, ROSALBA MILEDYS (LPN)
Entity type:Individual
Prefix:
First Name:ROSALBA
Middle Name:MILEDYS
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 TIEMANN AVE
Mailing Address - Street 2:BSMT
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2751
Mailing Address - Country:US
Mailing Address - Phone:347-449-7282
Mailing Address - Fax:
Practice Address - Street 1:3404 TIEMANN AVE
Practice Address - Street 2:BSMT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2751
Practice Address - Country:US
Practice Address - Phone:347-449-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse