Provider Demographics
NPI:1841902970
Name:ROBERT, NAOMIE (A-GNP-C)
Entity type:Individual
Prefix:
First Name:NAOMIE
Middle Name:
Last Name:ROBERT
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:NAOMIE
Other - Middle Name:
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP
Mailing Address - Street 1:PO BOX 746088
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6088
Mailing Address - Country:US
Mailing Address - Phone:469-727-6675
Mailing Address - Fax:
Practice Address - Street 1:712 BROAD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-1465
Practice Address - Country:US
Practice Address - Phone:401-233-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG12220054363LG0600X
RIAPRN03771363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology