Healthcare Provider Details

I. General information

NPI: 1861439556
Provider Name (Legal Business Name): PATRICIA LOUISE ROBERTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

IV. Provider business mailing address

310 COUNTY ROAD 14
DEL NORTE CO
81132-8719
US

V. Phone/Fax

Practice location:
  • Phone: 719-657-4102
  • Fax: 719-657-4106
Mailing address:
  • Phone: 719-657-2418
  • Fax: 719-657-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number175502
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: