1760592554 NPI number — CECILIA ROSE ROBERTS BSN MPH MSN

Table of content: CECILIA ROSE ROBERTS BSN MPH MSN (NPI 1760592554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760592554 NPI number — CECILIA ROSE ROBERTS BSN MPH MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
CECILIA
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN MPH MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STROM
Provider Other First Name:
CECILIA
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760592554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4810 RUSINA RD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80907-8104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-358-5377
Provider Business Mailing Address Fax Number:
719-323-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4810 RUSINA RD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80907-8104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-358-5377
Provider Business Practice Location Address Fax Number:
719-323-2705
Provider Enumeration Date:
08/30/2006

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: 163W00000X , with the licence number:  108079 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: RXP100287 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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