Provider Demographics
NPI:1912327123
Name:ROBERGE, KATHLEEN (MSN, NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ROBERGE
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4726
Mailing Address - Country:US
Mailing Address - Phone:401-855-6233
Mailing Address - Fax:
Practice Address - Street 1:3655 NOBEL DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1003
Practice Address - Country:US
Practice Address - Phone:888-435-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37711363LG0600X
MARN2279104363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology