Provider Demographics
NPI:1427770551
Name:ROLAND, STACY LEE (RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LEE
Last Name:ROLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8355
Mailing Address - Country:US
Mailing Address - Phone:414-526-5929
Mailing Address - Fax:
Practice Address - Street 1:3560 S CARI ADAM CIR
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53146-3007
Practice Address - Country:US
Practice Address - Phone:414-617-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178021-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health