Healthcare Provider Details

I. General information

NPI: 1376504225
Provider Name (Legal Business Name): KAREN M ROBERSON NMNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W. HARVARD AVE. SUITE 542
ROSEBURG OR
97471-2752
US

IV. Provider business mailing address

2570 NW EDENBOWER BLVD STE 100
ROSEBURG OR
97471-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-7200
  • Fax: 541-229-3309
Mailing address:
  • Phone: 541-677-7200
  • Fax: 541-229-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number093003343N5
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: