Provider Demographics
NPI:1265211759
Name:ROBERTSON, SIERRA L (RN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JAMES MONROE DR
Mailing Address - Street 2:
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951-7168
Mailing Address - Country:US
Mailing Address - Phone:304-753-5182
Mailing Address - Fax:
Practice Address - Street 1:142 JAMES MONROE DR
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951-7168
Practice Address - Country:US
Practice Address - Phone:304-753-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101197163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool