Healthcare Provider Details

I. General information

NPI: 1225258874
Provider Name (Legal Business Name): SANDRA ROBERTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 JEB STUART HWY
STUART VA
24171-1559
US

IV. Provider business mailing address

280 5TH AVE
COLLINSVILLE VA
24078-2483
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-8600
  • Fax:
Mailing address:
  • Phone: 276-647-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017001609
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: