Healthcare Provider Details

I. General information

NPI: 1952820342
Provider Name (Legal Business Name): CHERYL ANN ROBERTSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 09/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3973
US

IV. Provider business mailing address

1141 MARIGOLD DR NE
ALBUQUERQUE NM
87122-1112
US

V. Phone/Fax

Practice location:
  • Phone: 505-348-3736
  • Fax:
Mailing address:
  • Phone: 301-919-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02504
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: