Healthcare Provider Details

I. General information

NPI: 1821040205
Provider Name (Legal Business Name): FAITH ANN ROBERTS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

611 N STATE ST
STANTON MI
48888-9702
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax:
Mailing address:
  • Phone: 989-831-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704380057
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: