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General NPI Number Information
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NPI Number | 1114082906
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Entity Type | Individual
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Provider Name | KATHRYN COLLEEN ROBERTSON FNP
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Gender | Female
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 302 S 1ST AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1258
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Country | US
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Telephone | 208-263-5109
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Fax | 208-263-5112
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Provider Business Mailing Address
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Address Line | 6280 HIGHWAY 2
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City | SANDPOINT
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State | ID
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Zip | 83864-8381
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Country | US
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Telephone | 208-265-9532
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Fax | 208-263-5112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP342
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License Number State | ID
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