Provider Demographics
NPI:1790749281
Name:ROBERTSHAW, JEAN MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:ROBERTSHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:KURDILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANRP
Mailing Address - Street 1:1525 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4200
Mailing Address - Country:US
Mailing Address - Phone:404-728-6363
Mailing Address - Fax:
Practice Address - Street 1:WELLBE SENIOR MEDICAL
Practice Address - Street 2:1155 PERIMETER CENTER W, 11TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:855-492-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN075809363L00000X
FLARNP3145232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306186800Medicaid
FLU1127XMedicare PIN
P95749Medicare UPIN