Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209-006536 | IL |
Y | 363LW0102X | Nurse Practitioner - Women's Health | SP010349 | PA |
NPI | 1023263175 |
---|---|
Provider Name | Dawn Diane Roberson |
First Address | Indiana, PA 15701-1651 |
Second Address | Indiana, PA 15701-1651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2008 |
Last Update Date | 20/12/2011 |