Provider Demographics
NPI:1588824122
Name:ROBERTS, MAGGIE A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3159
Mailing Address - Country:US
Mailing Address - Phone:870-793-8900
Mailing Address - Fax:
Practice Address - Street 1:1355 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3159
Practice Address - Country:US
Practice Address - Phone:870-793-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL45395164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse