Healthcare Provider Details

I. General information

NPI: 1679941314
Provider Name (Legal Business Name): VALERIE L ROBERTSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS VALERIE L MARSH

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE SUITE 404
ROXBURY CROSSING MA
02120-2847
US

IV. Provider business mailing address

256 MEDFORD ST APT 6
BOSTON MA
02129-1930
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5000
  • Fax:
Mailing address:
  • Phone: 850-417-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2276771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: