Provider Demographics
NPI:1922361302
Name:ROBERTSON, NICOLE REBECCA (MD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:REBECCA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E M 36
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8133
Mailing Address - Country:US
Mailing Address - Phone:734-878-1000
Mailing Address - Fax:734-878-1001
Practice Address - Street 1:1255 E M 36
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8133
Practice Address - Country:US
Practice Address - Phone:734-878-1000
Practice Address - Fax:734-878-1001
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine