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Individual
JEREMY DEAN ROBERTSON
Active
Individual
JEREMY DEAN ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
201242599RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201242599RN
OREGON STATE BOARD OF NURSING
OR
Enumeration date
03/14/2022
Last updated
03/14/2022
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