Provider Demographics
NPI:1902058761
Name:ROBERTS, CHRISTINE ANN (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6436 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:WI
Mailing Address - Zip Code:53926-9353
Mailing Address - Country:US
Mailing Address - Phone:608-697-4483
Mailing Address - Fax:
Practice Address - Street 1:W6436 E OAK ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:WI
Practice Address - Zip Code:53926-9353
Practice Address - Country:US
Practice Address - Phone:608-697-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12-049176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife