Provider Demographics
NPI:1497290621
Name:ROBERTSON, EMILY ANN (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33053 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1822
Mailing Address - Country:US
Mailing Address - Phone:734-673-8892
Mailing Address - Fax:
Practice Address - Street 1:43033 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3375
Practice Address - Country:US
Practice Address - Phone:734-927-5050
Practice Address - Fax:734-937-5056
Is Sole Proprietor?:No
Enumeration Date:2016-12-25
Last Update Date:2016-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant