Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | A005016 | AR |
NPI | 1043757271 |
---|---|
Provider Name | Michelle Robertson |
First Address | Little Rock, AR 72212-2796 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2017 |
Last Update Date | 25/09/2019 |