MEDICARE: SUSAN BLIGH ROBERTSON CNM

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	367A00000X	Advanced Practice Midwife	CNM8247106	AZ

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	:	1902877590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BLIGH ROBERTSON CNM

Provider Business Mailing Address
First Line	:	5423 BLACK BEAR WAY
Second Line	:
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5514
Country	:	US
Telephone Number	:	928-368-5493
Fax Number	:

Provider Business Practice Location Address
First Line	:	5658 HIGHWAY 260
Second Line	:	SUITE 24
City	:	LAKESIDE
State	:	AZ
Zip	:	85929-5189
Country	:	US
Telephone Number	:	928-537-4379
Fax Number	:	928-537-4653

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/24/2007

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