MEDICARE: MS. SHAWN ADELE ROBERTS MS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	166	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295878429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAWN ADELE ROBERTS MS FNP

Provider Business Mailing Address
First Line	:	22626 LAKE HILL DR.
Second Line	:
City	:	CHUGIAK
State	:	AK
Zip	:	99567
Country	:	US
Telephone Number	:	907-440-6450
Fax Number	:	907-688-8453

Provider Business Practice Location Address
First Line	:	950 E BOGARD RD
Second Line	:	SUITE 103
City	:	WASILLA
State	:	AK
Zip	:	99654-7184
Country	:	US
Telephone Number	:	907-352-2880
Fax Number	:	907-352-2885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/05/2013

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