MEDICARE: VALORIE J ROBERTS

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	163W00000X	Registered Nurse	72364-030	WI

General Provider Information

NPI Number	:	1558677237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALORIE J ROBERTS

Provider Business Mailing Address
First Line	:	10282 W FOUNTAIN AVE APT 1301
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3243
Country	:	US
Telephone Number	:	608-588-1969
Fax Number	:	414-446-8255

Provider Business Practice Location Address
First Line	:	10282 W FOUNTAIN AVE APT #1301
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224
Country	:	US
Telephone Number	:	608-588-1969
Fax Number	:	414-446-8255

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

Provider Enumeration Date	:	08/19/2010
Last Update Date	:	12/13/2010

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