Provider Demographics
NPI:1992567960
Name:ROBERSON, LAURA R (HEALTH COACCH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:HEALTH COACCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 KILCOLGAN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4314
Mailing Address - Country:US
Mailing Address - Phone:916-995-2552
Mailing Address - Fax:
Practice Address - Street 1:9525 KILCOLGAN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4314
Practice Address - Country:US
Practice Address - Phone:916-995-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach