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Individual

MIA WALLIN ROBERTS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CPNP

Contact information

Practice address
4107 S FEDERAL BLVD STE B, ENGLEWOOD, CO 80110-4316
(303) 315-6150
Mailing address
13120 E 19TH AVE C288-5, AURORA, CO 80045
(303) 724-8555
(303) 724-4729

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
AP07790
LA
363LP0200X
Pediatric Nurse Practitioner
Primary
APN.0990539-NP
CO

Other

Enumeration date
01/03/2014
Last updated
03/17/2018
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