Healthcare Provider Details

I. General information

NPI: 1295010114
Provider Name (Legal Business Name): AMBER DAWN ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER DAWN ARRANT APRN

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 BETIN AVE
MONROE LA
71201-7257
US

IV. Provider business mailing address

21 GLADNEY LOOP
RAYVILLE LA
71269-5536
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1250
  • Fax:
Mailing address:
  • Phone: 318-372-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06545
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO6545
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: