Provider Demographics
NPI:1932106432
Name:ROBERTS, CAROLYN (MSN, RN, APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSN, RN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3692 STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8063
Mailing Address - Country:US
Mailing Address - Phone:505-471-2169
Mailing Address - Fax:
Practice Address - Street 1:3692 STATE ROAD 14
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8063
Practice Address - Country:US
Practice Address - Phone:505-471-2169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR12461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily