Healthcare Provider Details

I. General information

NPI: 1427411487
Provider Name (Legal Business Name): HEATHER JOHNSON ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE MU 320 WEST
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-6548
  • Fax:
Mailing address:
  • Phone: 507-254-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number71251
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: