Provider Demographics
NPI:1710998281
Name:ROBERTSON, PATRICIA (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 KNOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8618
Mailing Address - Country:US
Mailing Address - Phone:336-766-6031
Mailing Address - Fax:
Practice Address - Street 1:PIEDMONT TRIAD ANESTHESIA, PA
Practice Address - Street 2:145 KIMEL PARK DR.
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-768-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15498163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050000Medicaid
NC8050000Medicaid