Healthcare Provider Details

I. General information

NPI: 1841079639
Provider Name (Legal Business Name): DENISE ADRIANE ROBERTS DNP,MSN-ED,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DENISE ADRIANE DRAKE

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 ROADRUNNER DR
CORONA CA
92881-0709
US

IV. Provider business mailing address

1384 ROADRUNNER DR
CORONA CA
92881-0709
US

V. Phone/Fax

Practice location:
  • Phone: 951-536-3316
  • Fax:
Mailing address:
  • Phone: 951-536-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number462608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: