Healthcare Provider Details

I. General information

NPI: 1467900563
Provider Name (Legal Business Name): ERIN ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 SAINT GILES ST
RALEIGH NC
27612-7043
US

IV. Provider business mailing address

6350 QUADRANGLE DR STE 135
CHAPEL HILL NC
27517-7803
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-3870
  • Fax:
Mailing address:
  • Phone: 919-354-7077
  • Fax: 919-354-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008897
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: