Provider Demographics
NPI:1194321620
Name:ROBERTSON, CHRISTINE LENORE (BSN, RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LENORE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 43RD ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3411
Mailing Address - Country:US
Mailing Address - Phone:515-330-9797
Mailing Address - Fax:
Practice Address - Street 1:2808 43RD ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3411
Practice Address - Country:US
Practice Address - Phone:515-330-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2746102163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2746102OtherRN LICENSE