Provider Demographics
NPI:1942563697
Name:ROBERTSON, LAURIE L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17521 ST LUKES WAY
Mailing Address - Street 2:#160
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8039
Mailing Address - Country:US
Mailing Address - Phone:936-321-2200
Mailing Address - Fax:
Practice Address - Street 1:17521 ST LUKES WAY
Practice Address - Street 2:#160
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8039
Practice Address - Country:US
Practice Address - Phone:936-321-2200
Practice Address - Fax:936-321-5041
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily