Provider Demographics
NPI:1699911776
Name:ROBERTSON, SIERRA STARR (LPN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:STARR
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 HARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5025
Mailing Address - Country:US
Mailing Address - Phone:513-464-3932
Mailing Address - Fax:
Practice Address - Street 1:3902 HARDEN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5025
Practice Address - Country:US
Practice Address - Phone:513-464-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 359736163W00000X
OHPN.132971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse