Healthcare Provider Details

I. General information

NPI: 1568113280
Provider Name (Legal Business Name): DEBORAH ANN ROBERTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MONTGOMERY DR
SANTA ROSA CA
95404-6615
US

IV. Provider business mailing address

50 MONTGOMERY DR
SANTA ROSA CA
95404-6615
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-7780
  • Fax: 707-585-7784
Mailing address:
  • Phone: 707-585-7780
  • Fax: 707-585-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: