Provider Demographics
NPI:1720382880
Name:ROBERTS, COURTNEY ANNE (RN)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:ANNE
Last Name:ROBERTS
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 1:3611 31ST AVE
Mailing Address - Street 2:APT. 3G
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1050
Mailing Address - Country:US
Mailing Address - Phone:717-968-8004
Mailing Address - Fax:
Practice Address - Street 1:3611 31ST AVE
Practice Address - Street 2:APT. 3G
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1050
Practice Address - Country:US
Practice Address - Phone:717-968-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637988-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse