Provider Demographics
NPI:1700207016
Name:ROBERTS, CYNTHIA (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7905
Mailing Address - Country:US
Mailing Address - Phone:979-204-9614
Mailing Address - Fax:979-764-5124
Practice Address - Street 1:713 DOVER DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7905
Practice Address - Country:US
Practice Address - Phone:979-204-9614
Practice Address - Fax:979-764-5124
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741695163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator