Provider Demographics
NPI:1902352917
Name:ROELL, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24980 ZINSER RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47022-9714
Mailing Address - Country:US
Mailing Address - Phone:513-252-3449
Mailing Address - Fax:
Practice Address - Street 1:24980 ZINSER RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:IN
Practice Address - Zip Code:47022-9714
Practice Address - Country:US
Practice Address - Phone:513-252-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer