Healthcare Provider Details

I. General information

NPI: 1932646965
Provider Name (Legal Business Name): KATRINA ROBERTSON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2017
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CHESTNUT ST
NEEDHAM MA
02492-2505
US

IV. Provider business mailing address

178 FISHER ST NA
WALPOLE MA
02081-3927
US

V. Phone/Fax

Practice location:
  • Phone: 781-453-7607
  • Fax:
Mailing address:
  • Phone: 404-625-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN285004
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN285004
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: