Provider Demographics
NPI:1255972089
Name:ROLLER, CORINNE N (PA-C)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:N
Last Name:ROLLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:113 SUWANEE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1044
Mailing Address - Country:US
Mailing Address - Phone:269-275-4836
Mailing Address - Fax:
Practice Address - Street 1:8450 N 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9418
Practice Address - Country:US
Practice Address - Phone:269-552-2500
Practice Address - Fax:269-552-2545
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009624363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical