Individual
TERESA L ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805
(260) 481-2700
(260) 481-2709
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 481-2700
(260) 481-2709
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
28195388A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71008269A
IN
Other
Enumeration date
06/29/2011
Last updated
10/11/2022
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