MEDICARE: MS. CHERYL ANN ROBERTSON NP

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	363L00000X	Nurse Practitioner	CNP-02504	NM

General Provider Information

NPI Number	:	1952820342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL ANN ROBERTSON NP

Provider Business Mailing Address
First Line	:	1141 MARIGOLD DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-1112
Country	:	US
Telephone Number	:	301-919-4860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4775 INDIAN SCHOOL RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3973
Country	:	US
Telephone Number	:	505-348-3736
Fax Number	:

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

Provider Enumeration Date	:	09/17/2017
Last Update Date	:	09/17/2017

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