Provider Demographics
NPI:1043322597
Name:ROBERTS, CONNIE JANE (CRNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:JANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-543-6962
Mailing Address - Fax:410-548-5151
Practice Address - Street 1:300 WEST CARROLL STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-543-6962
Practice Address - Fax:410-548-5151
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO86902363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health