Provider Demographics
NPI:1942244058
Name:ROBERSON, LOIS CAROL (APNP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:CAROL
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:LOIS
Other - Middle Name:CAROL
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3690
Mailing Address - Fax:414-266-3676
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3690
Practice Address - Fax:414-266-3676
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2076363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942244058Medicaid
WI73601 2378Medicaid
P57829Medicare UPIN
WI73601 2378Medicaid