Provider Demographics
NPI:1518684356
Name:ROBERTSON, MARQUITA DEIONNA
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:DEIONNA
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 1:1920 RIDGECREST CT SE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6209
Mailing Address - Country:US
Mailing Address - Phone:202-751-5236
Mailing Address - Fax:
Practice Address - Street 1:1920 RIDGECREST CT SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6209
Practice Address - Country:US
Practice Address - Phone:202-751-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002239390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program