MEDICARE: MS. CAROLYN ROBERTS MSN, RN, APRN, BC

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	R12461	NM

General Provider Information

NPI Number	:	1932106432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN ROBERTS MSN, RN, APRN, BC

Provider Business Mailing Address
First Line	:	3692 STATE ROAD 14
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-8063
Country	:	US
Telephone Number	:	505-471-2169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3692 STATE ROAD 14
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-8063
Country	:	US
Telephone Number	:	505-471-2169
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/21/2009

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