Provider Demographics
NPI:1023643434
Name:CODLYN, ROCHELLE ALLEXIA (MBA,MSN, AGNP-C)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:ALLEXIA
Last Name:CODLYN
Suffix:
Gender:F
Credentials:MBA,MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 MANLEY DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9688
Mailing Address - Country:US
Mailing Address - Phone:608-286-4641
Mailing Address - Fax:
Practice Address - Street 1:2268 MANLEY DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9688
Practice Address - Country:US
Practice Address - Phone:608-286-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIAG01200090363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care