MEDICARE: COURTNEY ROBERTSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0996572	CO

General Provider Information

NPI Number	:	1053946681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ROBERTSON

Provider Business Mailing Address
First Line	:	617 DETROIT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 DETROIT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3831
Country	:	US
Telephone Number	:	336-782-8256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	01/08/2024

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Directions to “ COURTNEY ROBERTSON ” Practice Location

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