Healthcare Provider Details

I. General information

NPI: 1841250859
Provider Name (Legal Business Name): NANCY ELLEN ROBERTS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E SEMINOLE ST
SPRINGFIELD MO
65804-2227
US

IV. Provider business mailing address

ST. JOHN'S CLINIC, INC. P.O. BOX 2580
SPRINGFIELD MO
65801-2580
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2064
  • Fax:
Mailing address:
  • Phone: 417-829-4620
  • Fax: 417-829-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number057795
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: