Individual
NICHOLE ELAINE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
9470 BROADWAY, CROWN POINT, IN 46307-5722
(219) 661-3260
(219) 662-3770
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008738A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300027444
—
IN
Enumeration date
02/11/2019
Last updated
09/14/2023
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