Provider Demographics
NPI:1073188348
Name:ROBERTS, EDITH YVONNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:YVONNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:YVONNE
Other - Last Name:LANGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3007
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3007
Mailing Address - Country:US
Mailing Address - Phone:503-535-1166
Mailing Address - Fax:503-546-8340
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2327
Practice Address - Country:US
Practice Address - Phone:503-535-1151
Practice Address - Fax:503-546-8340
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096007861163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse