Provider Demographics
NPI:1619355898
Name:ROBERTSON, CAREY M (CNP)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:HEBBELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 FARRELL CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-1677
Mailing Address - Country:US
Mailing Address - Phone:513-451-6871
Mailing Address - Fax:513-451-6876
Practice Address - Street 1:425 FARRELL CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-1677
Practice Address - Country:US
Practice Address - Phone:513-451-6871
Practice Address - Fax:513-451-6876
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17578-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140327Medicaid
OHH375820Medicare PIN