Provider Demographics
NPI:1225742232
Name:MCROBERT, PRISCILLA (THW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MCROBERT
Suffix:
Gender:F
Credentials:THW
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:RIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THW
Mailing Address - Street 1:906 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-3816
Mailing Address - Country:US
Mailing Address - Phone:503-801-3838
Mailing Address - Fax:503-815-1870
Practice Address - Street 1:906 MAIN AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3816
Practice Address - Country:US
Practice Address - Phone:503-801-3838
Practice Address - Fax:503-815-1870
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105606175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000105606OtherTRADITIONAL HEALTH WORKER