Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 22642 | MS |
N | 208600000X | Surgeon | 22642 | MS |
Y | 2086S0102X | Surgical Critical Care | 2004031001 | MO |
NPI | 1215019518 |
---|---|
Provider Name | Dr. Theresa Elizabeth Robertson |
First Address | Kansas City, MO 64131-4517 |
Second Address | Kansas City, MO 64111-5942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 11/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08220715 | (05) | MS |
2407015 | (05) | LA |