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General NPI Number Information
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NPI Number | 1730272147
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Entity Type | Individual
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Provider Name | WANDA ROBERTON MD
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Gender | Female
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 32020 1ST AVE S SUITE 115
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5717
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Country | US
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Telephone | 253-838-6556
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Fax | 253-661-4523
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Provider Business Mailing Address
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Address Line | 32020 1ST AVE S SUITE 115
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5717
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Country | US
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Telephone | 253-838-6556
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Fax | 253-661-4523
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD00018181
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License Number State | WA
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