Individual
ETTA DEAN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 N 75TH ST, MILWAUKEE, WI 53216-2742
(414) 793-6595
Mailing address
3100 N 75TH ST, MILWAUKEE, WI 53216-2742
(414) 793-6595
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
R1632048689103
WI
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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