Provider Demographics
NPI:1619164340
Name:ROBERTSON, DEBORAH H (APRN, BC, FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:H
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 THORNBROOK TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9741
Mailing Address - Country:US
Mailing Address - Phone:573-234-1341
Mailing Address - Fax:573-884-5735
Practice Address - Street 1:#1 HOSP DR MC-11, DCO92.10
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-9924
Practice Address - Fax:573-884-5735
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO078236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO078236OtherAPRN, BC, FNP