Provider Demographics
NPI:1700557584
Name:DESROBERTS, COURTNEYBELLE MUNRO (BSN, RN, CPN)
Entity Type:Individual
Prefix:
First Name:COURTNEYBELLE
Middle Name:MUNRO
Last Name:DESROBERTS
Suffix:
Gender:F
Credentials:BSN, RN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 PLUM ST APT 403
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1525
Mailing Address - Country:US
Mailing Address - Phone:315-200-5485
Mailing Address - Fax:
Practice Address - Street 1:525 PLUM ST APT 403
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1525
Practice Address - Country:US
Practice Address - Phone:315-200-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY718004163WP0200X
NY718004-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY718004OtherREGISTERED NURSE