Provider Demographics
NPI:1396323689
Name:ROBERTSON, SUSAN LYNN (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
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Other - Suffix:
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Mailing Address - Street 1:108 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2602
Mailing Address - Country:US
Mailing Address - Phone:928-425-6592
Mailing Address - Fax:
Practice Address - Street 1:108 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2602
Practice Address - Country:US
Practice Address - Phone:928-425-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ256063207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine