Provider Demographics
NPI:1629777909
Name:ROBERTSON, CELIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 ASHANTILLY AVE
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-3607
Mailing Address - Country:US
Mailing Address - Phone:912-419-5127
Mailing Address - Fax:
Practice Address - Street 1:414 ASHANTILLY AVE
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-3607
Practice Address - Country:US
Practice Address - Phone:912-419-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA286238163W00000X
VAL-17581163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty