Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R148166 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R148166 | MD |
NPI | 1023665163 |
---|---|
Provider Name | Miss Sedelle Yvette Roberts |
First Address | Aberdeen, MD 21001-1848 |
Second Address | Baltimore, MD 21215-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 22/08/2019 |