Provider Demographics
NPI:1255666129
Name:ROBERTSON, SHANE DIANE (RN)
Entity Type:Individual
Prefix:MS
First Name:SHANE
Middle Name:DIANE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2021
Mailing Address - Country:US
Mailing Address - Phone:615-995-5485
Mailing Address - Fax:
Practice Address - Street 1:100 W BURTON ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3657
Practice Address - Country:US
Practice Address - Phone:615-898-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000151427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse