Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RO86902 | MD |
NPI | 1043322597 |
---|---|
Provider Name | Ms. Connie Jane Roberts |
First Address | Salisbury, MD 21801 |
Second Address | Salisbury, MD 21801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 31/05/2012 |