Provider Demographics
NPI:1003547381
Name:ROBERTS, ELISABETH WEISS (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:WEISS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BUENA VISTA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-4107
Mailing Address - Country:US
Mailing Address - Phone:415-505-2546
Mailing Address - Fax:
Practice Address - Street 1:777 BUENA VISTA AVE W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4107
Practice Address - Country:US
Practice Address - Phone:415-505-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833124163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant