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General NPI Number Information
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NPI Number | 1295878429
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Entity Type | Individual
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Provider Name | SHAWN ADELE ROBERTS MS FNP
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 950 E BOGARD RD SUITE 103
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City | WASILLA
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State | AK
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Zip | 99654-7184
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Country | US
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Telephone | 907-352-2880
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Fax | 907-352-2885
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Provider Business Mailing Address
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Address Line | 22626 LAKE HILL DR.
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City | CHUGIAK
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State | AK
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Zip | 99567
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Country | US
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Telephone | 907-440-6450
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Fax | 907-688-8453
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 166
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License Number State | AK
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