Provider Demographics
NPI:1114256005
Name:ROBERTS, JEAN M (MSN, RN, PHN, CNL)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, RN, PHN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MOUNT VERNON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3302
Mailing Address - Country:US
Mailing Address - Phone:661-868-1219
Mailing Address - Fax:661-868-0218
Practice Address - Street 1:1800 MOUNT VERNON AVE FL 2
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3302
Practice Address - Country:US
Practice Address - Phone:661-868-1219
Practice Address - Fax:661-868-0218
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 720840163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health