MEDICARE: SHEILA ROBERTSON LPN

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	164W00000X	Licensed Practical Nurse	LP52183	MD

General Provider Information

NPI Number	:	1942736640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA ROBERTSON LPN

Provider Business Mailing Address
First Line	:	16011 EVERLY RD
Second Line	:
City	:	HAGERSTOWN
State	:	MD
Zip	:	21740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 PRIVATE CT.
Second Line	:
City	:	BUNKER HILL
State	:	WV
Zip	:	25413
Country	:	US
Telephone Number	:	301-714-0837
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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