Healthcare Provider Details

I. General information

NPI: 1417549312
Provider Name (Legal Business Name): CRISTINE ANN ROBERTS RN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 01/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E ASHLEY AVE
FOLLY BEACH SC
29439
US

IV. Provider business mailing address

PO BOX 1616
FOLLY BEACH SC
29439-1616
US

V. Phone/Fax

Practice location:
  • Phone: 913-653-9166
  • Fax:
Mailing address:
  • Phone: 913-653-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number070731
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: