Provider Demographics
NPI:1427369685
Name:ROBERSON, JO ELLEN (RN)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:ELLEN
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JO
Other - Middle Name:ELLEN
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:2100 BULL ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:251-415-1496
Mailing Address - Fax:251-415-8601
Practice Address - Street 1:2100 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:251-415-1496
Practice Address - Fax:251-415-8601
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-058198367A00000X
SC106404163WA2000X
OR201400106RN163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife