Individual
MS. MAYA SHANNON ROLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCMA
Contact information
Practice address
900 WILKINSON ST, MANDEVILLE, LA 70448-3533
(985) 624-4450
(985) 624-4461
Mailing address
37203 WEST TIMBERLINE DRIVE, SLIDELL, LA 70460
(504) 252-1182
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Z3D8D5E5
LA
247200000X
Other Technician
Primary
W6R8Q5D7
LA
2472E0500X
EEG Technician
Y4X2G3P6
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA05334
CPR
LA
01
—
W6R8Q5D7
CERTIFIED CLINICAL MEDICAL ASSISTANT
LA
01
—
Y4X2G3P6
CERTIFIED EKG TECHNICIAN
LA
01
—
Z3D8D5E5
CERTIFIED PHLEBOTOMY TECHNICIAN
LA
Enumeration date
08/27/2015
Last updated
08/27/2015
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