Provider Demographics
NPI:1225204316
Name:TRUSCOTT, ROBERTA JEAN (RN, MPS)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:TRUSCOTT
Suffix:
Gender:F
Credentials:RN, MPS
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:JEAN
Other - Last Name:KOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3774 N SUTTERS WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-9140
Mailing Address - Country:US
Mailing Address - Phone:208-765-0294
Mailing Address - Fax:
Practice Address - Street 1:3774 N SUTTERS WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9140
Practice Address - Country:US
Practice Address - Phone:208-765-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-13024163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice