Provider Demographics
NPI:1417229980
Name:ROBERTSON, ELENA VLADIMIROVNA (CRNP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VLADIMIROVNA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 ITA ANN LANE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757
Mailing Address - Country:US
Mailing Address - Phone:256-882-7469
Mailing Address - Fax:256-425-0046
Practice Address - Street 1:7105B BAILEY CREEK CIR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2797
Practice Address - Country:US
Practice Address - Phone:256-882-7469
Practice Address - Fax:256-425-0046
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily