Provider Demographics
NPI:1255476487
Name:ROBERTS, WILNA MARIE (NMW765, RN354667)
Entity Type:Individual
Prefix:MRS
First Name:WILNA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NMW765, RN354667
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:771 BUSCHMANN RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5848
Mailing Address - Country:US
Mailing Address - Phone:530-872-7579
Mailing Address - Fax:530-872-5645
Practice Address - Street 1:771 BUSCHMANN RD
Practice Address - Street 2:SUITE H
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5848
Practice Address - Country:US
Practice Address - Phone:530-872-7579
Practice Address - Fax:530-872-5645
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW765367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife