Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MT199929 | PA |
N | 111NI0900X | Internist | MT199929 | PA |
NPI | 1003100900 |
---|---|
Provider Name | Dr. Traci Arnette Roberts |
First Address | Woodbury, MN 55125 |
Second Address | Burnsville, MN 55337-5714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2011 |
Last Update Date | 17/03/2018 |