MEDICARE: EURONDA FAY 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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1326790759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EURONDA FAY ROBERTSON

Provider Business Mailing Address
First Line	:	6584 POPLAR AVE FL 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38138-3687
Country	:	US
Telephone Number	:	901-378-4440
Fax Number	:	901-249-6004

Provider Business Practice Location Address
First Line	:	6584 POPLAR AVE FL 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38138-3687
Country	:	US
Telephone Number	:	901-378-4440
Fax Number	:	901-249-6004

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “ EURONDA FAY ROBERTSON ” Practice Location

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