1942244058 NPI number — MS. LOIS CAROL ROBERSON APNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942244058 NPI number — MS. LOIS CAROL ROBERSON APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
LOIS
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
LOIS
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942244058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
PEDIATRIC GASTROENTEROLOGY
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-266-3690
Provider Business Mailing Address Fax Number:
414-266-3676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
PEDIATRIC GASTROENTEROLOGY
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-3690
Provider Business Practice Location Address Fax Number:
414-266-3676
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  2076 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1942244058 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73601 2378 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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