Provider Demographics
NPI:1710994496
Name:ROBERTSON, DEBORAH DIANE (RNC,NNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DIANE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RNC,NNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNC,NNP
Mailing Address - Street 1:4755 PALMER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-9020
Mailing Address - Country:US
Mailing Address - Phone:307-331-0187
Mailing Address - Fax:
Practice Address - Street 1:4755 PALMER CANYON RD
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-9020
Practice Address - Country:US
Practice Address - Phone:307-331-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20381.24363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal