Provider Demographics
NPI:1215434584
Name:ROBERTSON, LIBRA (CRNP)
Entity type:Individual
Prefix:MS
First Name:LIBRA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 CHESSINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1857
Mailing Address - Country:US
Mailing Address - Phone:443-743-8129
Mailing Address - Fax:410-498-7244
Practice Address - Street 1:100 E PENNSYLVANIA AVE STE 304
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-0701
Practice Address - Country:US
Practice Address - Phone:410-498-4808
Practice Address - Fax:410-498-7244
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208116363LF0000X, 163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care