Provider Demographics
NPI:1285984070
Name:ROLLS, JOANNE NICHOLE RICHARDS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:NICHOLE RICHARDS
Last Name:ROLLS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:375 S CHIPETA WAY STE A
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1261
Mailing Address - Country:US
Mailing Address - Phone:801-587-3355
Mailing Address - Fax:
Practice Address - Street 1:1280 E STRINGHAM AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2490
Practice Address - Country:US
Practice Address - Phone:801-581-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8433278-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant