Provider Demographics
NPI:1710644950
Name:ROBERTS, COURTNEY MICHELLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8508 LOCH RAVEN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2354
Mailing Address - Country:US
Mailing Address - Phone:443-219-7349
Mailing Address - Fax:
Practice Address - Street 1:8508 LOCH RAVEN BLVD STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2354
Practice Address - Country:US
Practice Address - Phone:443-219-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily