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General NPI Number Information
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NPI Number | 1447793765
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Entity Type | Individual
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Provider Name | ELIZABETH TEMPLE ROBERSON
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Gender | Female
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 3611 BRANCH AVE #106
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City | TEMPLE HILLS
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State | MD
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Zip | 20748-1242
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Country | US
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Telephone | 301-316-2009
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Fax | 301-316-2115
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Provider Business Mailing Address
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Address Line | 3611 BRANCH AVE #106
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City | TEMPLE HILLS
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State | MD
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Zip | 20748-1242
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Country | US
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Telephone | 301-316-2009
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Fax | 301-316-2115
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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 | R108764
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License Number State | MD
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