Provider Demographics
NPI:1477105336
Name:ROBERTSON, VICKY LYNN
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-0840
Mailing Address - Country:US
Mailing Address - Phone:434-688-1193
Mailing Address - Fax:
Practice Address - Street 1:325 NEIGHBORHOOD RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-4444
Practice Address - Country:US
Practice Address - Phone:434-688-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)