Provider Demographics
NPI:1659886810
Name:ROBERTSON, LAURA MEGHANN (NP-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MEGHANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CARLYLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1058
Mailing Address - Country:US
Mailing Address - Phone:419-690-0075
Mailing Address - Fax:
Practice Address - Street 1:521 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-349-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner