Provider Demographics
NPI:1275295719
Name:ROBERTSON, MARILYN (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
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 1:2901 SPRING COVE WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8389
Mailing Address - Country:US
Mailing Address - Phone:859-512-9892
Mailing Address - Fax:
Practice Address - Street 1:4750 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:OH
Practice Address - Zip Code:45212-2244
Practice Address - Country:US
Practice Address - Phone:513-569-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1104141163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse