Provider Demographics
NPI:1841079639
Name:ROBERTS, DENISE ADRIANE (DNP,MSN-ED,RN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ADRIANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DNP,MSN-ED,RN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ADRIANE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1384 ROADRUNNER DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-0709
Mailing Address - Country:US
Mailing Address - Phone:951-536-3316
Mailing Address - Fax:
Practice Address - Street 1:1384 ROADRUNNER DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-0709
Practice Address - Country:US
Practice Address - Phone:951-536-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462608163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty