Healthcare Provider Details

I. General information

NPI: 1144294422
Provider Name (Legal Business Name): DONNA M ROBERTSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date: 03/31/2006
Reactivation Date: 09/16/2009

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8400
  • Fax:
Mailing address:
  • Phone: 505-272-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR56993
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: