Provider Demographics
NPI:1912443854
Name:ROBERTSON, CATERINA ELANA (RN)
Entity Type:Individual
Prefix:
First Name:CATERINA
Middle Name:ELANA
Last Name:ROBERTSON
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 1:1217 NE BURNSIDE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6722
Mailing Address - Country:US
Mailing Address - Phone:503-492-2625
Mailing Address - Fax:
Practice Address - Street 1:1217 NE BURNSIDE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6722
Practice Address - Country:US
Practice Address - Phone:503-492-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201700128RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse