Healthcare Provider Details

I. General information

NPI: 1033070867
Provider Name (Legal Business Name): LAURA ROBERTS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W MCKINLEY AVE
MISHAWAKA IN
46545-5599
US

IV. Provider business mailing address

529 MAIN ST
ROCHESTER IN
46975-1317
US

V. Phone/Fax

Practice location:
  • Phone: 574-282-3230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017256A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: