Healthcare Provider Details

I. General information

NPI: 1932106432
Provider Name (Legal Business Name): CAROLYN ROBERTS MSN, RN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 STATE ROAD 14
SANTA FE NM
87508-8063
US

IV. Provider business mailing address

3692 STATE ROAD 14
SANTA FE NM
87508-8063
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-2169
  • Fax:
Mailing address:
  • Phone: 505-471-2169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR12461
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: