Provider Demographics
NPI:1679198394
Name:ROBERSON, NORA PRISCILLA
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:PRISCILLA
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 WILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-7814
Mailing Address - Country:US
Mailing Address - Phone:252-801-5650
Mailing Address - Fax:
Practice Address - Street 1:413 MILL ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-4837
Practice Address - Country:US
Practice Address - Phone:252-801-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCT-3099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist