Provider Demographics
NPI:1427650753
Name:ROBERSON, ANTIONETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 ELLERY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0067
Mailing Address - Country:US
Mailing Address - Phone:252-702-8831
Mailing Address - Fax:
Practice Address - Street 1:937 ELLERY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0067
Practice Address - Country:US
Practice Address - Phone:252-702-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4122570163W00000X
NC215257163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163W00000XNursing Service ProvidersRegistered Nurse