Individual
ELLEN L ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1672
(260) 266-5370
(260) 266-5379
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001478A
IN
363LF0000X
Family Nurse Practitioner
71001478A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28113969A
REGISTERED NURSE LICENSE
IN
Enumeration date
05/04/2006
Last updated
10/20/2022
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