Provider Demographics
NPI:1548834856
Name:ROBERTSON, NETTIE
Entity type:Individual
Prefix:
First Name:NETTIE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:FRED
Mailing Address - State:TX
Mailing Address - Zip Code:77616-0181
Mailing Address - Country:US
Mailing Address - Phone:409-377-1451
Mailing Address - Fax:
Practice Address - Street 1:315 W GIBSON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4903
Practice Address - Country:US
Practice Address - Phone:409-384-5768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX924680163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse