Provider Demographics
NPI:1326790759
Name:ROBERTSON, EURONDA FAY
Entity Type:Individual
Prefix:
First Name:EURONDA
Middle Name:FAY
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6584 POPLAR AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3687
Mailing Address - Country:US
Mailing Address - Phone:901-378-4440
Mailing Address - Fax:901-249-6004
Practice Address - Street 1:6584 POPLAR AVE FL 2
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3687
Practice Address - Country:US
Practice Address - Phone:901-378-4440
Practice Address - Fax:901-249-6004
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide