Provider Demographics
NPI:1164827697
Name:ROBERTSON, AMY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N WAYNE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2867
Mailing Address - Country:US
Mailing Address - Phone:513-258-1113
Mailing Address - Fax:
Practice Address - Street 1:231 N WAYNE AVE
Practice Address - Street 2:APT 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2867
Practice Address - Country:US
Practice Address - Phone:513-258-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN38355998163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse