Provider Demographics
NPI:1083390157
Name:ROBERTSON, ASHLEY GENELL (LPN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GENELL
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:BROWNVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:68321-0192
Mailing Address - Country:US
Mailing Address - Phone:402-414-0538
Mailing Address - Fax:
Practice Address - Street 1:2103 O ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-2532
Practice Address - Country:US
Practice Address - Phone:402-274-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27220164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse