Provider Demographics
NPI:1417549312
Name:ROBERTS, CRISTINE ANN (RN PHD)
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1616
Mailing Address - Street 2:
Mailing Address - City:FOLLY BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29439-1616
Mailing Address - Country:US
Mailing Address - Phone:913-653-9166
Mailing Address - Fax:
Practice Address - Street 1:1620 E ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:FOLLY BEACH
Practice Address - State:SC
Practice Address - Zip Code:29439
Practice Address - Country:US
Practice Address - Phone:913-653-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO070731163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice