Provider Demographics
NPI:1669854287
Name:ROBERTSON, ALICE ANN (CNM, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ANN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CNM, FNP-C
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:ANN
Other - Last Name:HERMANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, FNP-C
Mailing Address - Street 1:579 BARNARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-5108
Mailing Address - Country:US
Mailing Address - Phone:770-823-1466
Mailing Address - Fax:
Practice Address - Street 1:4444 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2189
Practice Address - Country:US
Practice Address - Phone:980-495-0340
Practice Address - Fax:980-273-1115
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000824363LF0000X
NC567367A00000X
NC5012373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0479555Medicaid
DC23382385Medicaid
NY06879441Medicaid