Healthcare Provider Details

I. General information

NPI: 1588944680
Provider Name (Legal Business Name): JANELLE ROBERTSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73265 CONFEDERATED WAY
PENDLETON OR
97801-0160
US

IV. Provider business mailing address

79980 S FORK WALLA WALLA RIVER RD
MILTON FREEWATER OR
97862-7041
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-278-7572
Mailing address:
  • Phone: 541-938-6461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberO93000192RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: