Provider Demographics
NPI:1790853315
Name:TUMBERG, ROBERTA L (RN, MS, PMHCNS)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:TUMBERG
Suffix:
Gender:F
Credentials:RN, MS, PMHCNS
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:L
Other - Last Name:PULVER, ALBJERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-6260
Mailing Address - Country:US
Mailing Address - Phone:936-558-6200
Mailing Address - Fax:936-558-6201
Practice Address - Street 1:2001 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901
Practice Address - Country:US
Practice Address - Phone:936-558-6200
Practice Address - Fax:936-558-6201
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX842313163W00000X, 363LP0808X
MNR1654523163WP0808X
TXAP124297163WP0808X
LA224984363LP0808X
MN2005003879364S00000X
TXAP12497363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411G8PUOtherBCBS
TXAP124297OtherAPRN LICENSE
TX842313OtherRN LICENSE
MNHP55618OtherHEALTHPARTNERS
MN438944100Medicaid