1093954745 NPI number — MRS. CINDY LATRICE ROBERTS FNP

Table of content: MRS. CINDY LATRICE ROBERTS FNP (NPI 1093954745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093954745 NPI number — MRS. CINDY LATRICE ROBERTS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CINDY
Provider Middle Name:
LATRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093954745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8900 WISCONSIN AVE, BLDG 17A, 3RD FLR
Provider Second Line Business Mailing Address:
WALTER REED NATIONAL MILITARY MEDICAL CENTER
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-788-7129
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 STUART ST
Provider Second Line Business Practice Location Address:
MONCRIEF ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29207-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-751-2060
Provider Business Practice Location Address Fax Number:
803-751-2014
Provider Enumeration Date:
02/19/2009

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: 363LF0000X , with the licence number:  689948 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VAD 000 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".




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