Provider Demographics
NPI:1942405899
Name:DROBERG, REBECCA LYNN (CRNP ACNP, MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:DROBERG
Suffix:
Gender:F
Credentials:CRNP ACNP, MS
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Mailing Address - Street 1:174 WHITE OAK BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:STELLA
Mailing Address - State:NC
Mailing Address - Zip Code:28582-9707
Mailing Address - Country:US
Mailing Address - Phone:410-977-7771
Mailing Address - Fax:
Practice Address - Street 1:718 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8012
Practice Address - Country:US
Practice Address - Phone:252-393-6543
Practice Address - Fax:252-393-6545
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR161652363LA2100X
NC5007431363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1942405899Medicaid
NCM963AMedicare Oscar/Certification