Provider Demographics
NPI:1760592554
Name:ROBERTS, CECILIA ROSE (BSN MPH MSN)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:ROSE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BSN MPH MSN
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:ROSE
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:4810 RUSINA RD
Mailing Address - Street 2:STE B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8104
Mailing Address - Country:US
Mailing Address - Phone:719-358-5377
Mailing Address - Fax:719-323-2705
Practice Address - Street 1:4810 RUSINA RD
Practice Address - Street 2:STE B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8104
Practice Address - Country:US
Practice Address - Phone:719-358-5377
Practice Address - Fax:719-323-2705
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO108079163W00000X
CORXP100287363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse