Provider Demographics
NPI:1265104707
Name:ROBERTSON, NANCY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 12TH STREET CT
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1225
Mailing Address - Country:US
Mailing Address - Phone:563-659-6090
Mailing Address - Fax:
Practice Address - Street 1:2422 12TH STREET CT
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1225
Practice Address - Country:US
Practice Address - Phone:563-659-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily