Provider Demographics
NPI:1134919210
Name:ROBERTSON, KIRSTIN ELLEN
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ELLEN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 WAKEMAN DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-8538
Mailing Address - Country:US
Mailing Address - Phone:712-890-9193
Mailing Address - Fax:
Practice Address - Street 1:8010 KILPATRICK PKWY
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-3289
Practice Address - Country:US
Practice Address - Phone:402-350-6743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide