Provider Demographics
NPI:1407310220
Name:ROBERTSON, KAREN JEAN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JEAN
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 1:680 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1431
Mailing Address - Country:US
Mailing Address - Phone:541-271-6211
Mailing Address - Fax:
Practice Address - Street 1:680 FIR AVE
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1431
Practice Address - Country:US
Practice Address - Phone:541-271-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator