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General NPI Number Information
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NPI Number | 1356397657
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Entity Type | Individual
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Provider Name | DERRETH C ROBERTS ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 789 CENTRAL AVENUE
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City | DOVER
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State | NH
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Zip | 03820-2526
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Country | US
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Telephone | 603-740-2697
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ELIZABETH RD
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City | SOUTH BERWICK
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State | ME
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Zip | 03908-2174
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Country | US
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Telephone | 603-740-2649
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Fax |
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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 | 047079-23-05
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License Number State | NH
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