Provider Demographics
NPI:1629261433
Name:ROBERTSON, DIANE CECILE (CNM)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CECILE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 VINING RUN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934-8207
Mailing Address - Country:US
Mailing Address - Phone:302-697-0840
Mailing Address - Fax:302-697-8065
Practice Address - Street 1:1200 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-2202
Practice Address - Country:US
Practice Address - Phone:302-857-6393
Practice Address - Fax:302-857-7676
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK 0000134176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife