Provider Demographics
NPI:1669954095
Name:ROBERTS, RENEE L (RN, MSN, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 FORTUNA CENTER PLAZA STE 280
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025
Mailing Address - Country:US
Mailing Address - Phone:240-289-3887
Mailing Address - Fax:
Practice Address - Street 1:4222 FORTUNA CENTER PLAZA STE 280
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025
Practice Address - Country:US
Practice Address - Phone:240-289-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-01
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001278906163W00000X
VA0024177132363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse