MEDICARE: MRS. DEBRA GALE ROBERTS FNP

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	11665	CA

General Provider Information

NPI Number	:	1356549497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA GALE ROBERTS FNP

Provider Business Mailing Address
First Line	:	6079 N FRESNO ST
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6079 N FRESNO ST
Second Line	:	SUITE 101
City	:	FRESNO
State	:	CA
Zip	:	93710-5276
Country	:	US
Telephone Number	:	559-438-1400
Fax Number	:

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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