Healthcare Provider Details

I. General information

NPI: 1609655695
Provider Name (Legal Business Name): EFFIE ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 HEARTQUAKE TRCE
MOSELEY VA
23120-1646
US

IV. Provider business mailing address

16300 HEARTQUAKE TRCE
MOSELEY VA
23120-1646
US

V. Phone/Fax

Practice location:
  • Phone: 804-475-6223
  • Fax:
Mailing address:
  • Phone: 804-475-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: