Provider Demographics
NPI:1093363632
Name:ROBERTSON, DONNISHA
Entity Type:Individual
Prefix:
First Name:DONNISHA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10821 BEECH VALLEY CT APT 2-014
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8291
Mailing Address - Country:US
Mailing Address - Phone:336-549-8338
Mailing Address - Fax:
Practice Address - Street 1:10821 BEECH VALLEY CT APT 2-014
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8291
Practice Address - Country:US
Practice Address - Phone:336-549-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC287658163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse