Provider Demographics
NPI:1992892574
Name:ROBERTSON, ETHEL M (NP)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 DR DB TODD JR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2896
Mailing Address - Country:US
Mailing Address - Phone:615-291-9923
Mailing Address - Fax:615-678-6470
Practice Address - Street 1:404 DR DB TODD JR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2896
Practice Address - Country:US
Practice Address - Phone:615-291-9923
Practice Address - Fax:615-678-6470
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0256063-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33440461Medicaid
TN1992892574OtherMEDICARE NPI