Provider Demographics
NPI:1023554110
Name:ROBERTS, MARCI
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:ROBERTS
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 1:19935 E CHANDLER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9350
Mailing Address - Country:US
Mailing Address - Phone:480-420-2101
Mailing Address - Fax:480-398-2073
Practice Address - Street 1:19935 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9350
Practice Address - Country:US
Practice Address - Phone:480-420-2101
Practice Address - Fax:480-398-2073
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN191993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse