Provider Demographics
NPI:1245627017
Name:ROBERTSON, GINGER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ERIE MANOR LN APT 6
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9137
Mailing Address - Country:US
Mailing Address - Phone:337-884-3550
Mailing Address - Fax:
Practice Address - Street 1:2 ERIE MANOR LN APT 6
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9137
Practice Address - Country:US
Practice Address - Phone:337-884-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND203240363LP0808X
LARN140150163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse