Provider Demographics
NPI:1801861448
Name:ROBERTS, ELIZABETH UCHENNA, EHIRIM (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:UCHENNA, EHIRIM
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Mailing Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504
Mailing Address - Country:US
Mailing Address - Phone:816-436-7072
Mailing Address - Fax:816-436-2743
Practice Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-743-0912
Practice Address - Fax:816-221-7280
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164880363L00000X
TX818077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R08D625Medicare PIN
Q35835Medicare UPIN