Provider Demographics
NPI:1679941314
Name:ROBERTSON, VALERIE L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:VALERIE
Other - Middle Name:L
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 MEDFORD ST
Mailing Address - Street 2:APT 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1930
Mailing Address - Country:US
Mailing Address - Phone:850-417-9606
Mailing Address - Fax:
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily