Provider Demographics
NPI:1134760168
Name:ROBERSON, LENICE (CPT)
Entity type:Individual
Prefix:
First Name:LENICE
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 SAN JOSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2768
Mailing Address - Country:US
Mailing Address - Phone:502-310-2223
Mailing Address - Fax:
Practice Address - Street 1:1728 SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2768
Practice Address - Country:US
Practice Address - Phone:502-310-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYW2Y2P9L5246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy