Healthcare Provider Details

I. General information

NPI: 1609282946
Provider Name (Legal Business Name): CHRISTA NICOLE ROBERTSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA HALLOWELL

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9757 WESTPOINT DR STE 100
INDIANAPOLIS IN
46256-3329
US

IV. Provider business mailing address

1200 W WHITE RIVER BLVD
MUNCIE IN
47303-4988
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-0460
  • Fax:
Mailing address:
  • Phone: 877-668-5621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005034A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: