Healthcare Provider Details

I. General information

NPI: 1932861010
Provider Name (Legal Business Name): PATRICIA STULB ROBERTS RN, PMHCNS, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 RICHMOND RD
WILLIAMSBURG VA
23185-2821
US

IV. Provider business mailing address

905 RICHMOND RD
WILLIAMSBURG VA
23185-2821
US

V. Phone/Fax

Practice location:
  • Phone: 175-750-8272
  • Fax:
Mailing address:
  • Phone: 175-750-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0015000678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: