Healthcare Provider Details

I. General information

NPI: 1285178103
Provider Name (Legal Business Name): KATHLEEN ROBERTSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRE BLVD
MARLTON NJ
08053-4129
US

IV. Provider business mailing address

102 CENTRE BLVD
MARLTON NJ
08053-4129
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-6260
  • Fax:
Mailing address:
  • Phone: 856-988-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR17314500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: