Provider Demographics
NPI:1891135406
Name:KHOUZAM-ROBERTS, JOAN MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:KHOUZAM-ROBERTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-1219
Mailing Address - Country:US
Mailing Address - Phone:607-746-6999
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1219
Practice Address - Country:US
Practice Address - Phone:607-746-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338046-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily