Individual
LANORVELL ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1110 PROFESSIONAL CT, HAGERSTOWN, MD 21740-5826
(240) 420-5559
(240) 420-3786
Mailing address
PO BOX 790058, SAINT LOUIS, MO 63179-0058
(636) 549-2380
(314) 569-5974
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R036279
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KCB1CH
CAREFIRST BCBS
MD
01
—
P00745079
MEDCIARE RAILROAD (GRP PTAN DD6120)
MD
01
—
P00811167
MEDICARE RAILROAD (GRP PTAN CJ8689)
MD
01
—
S417-0037
CAREFIRST BCBS
DC
Enumeration date
09/20/2005
Last updated
05/07/2010
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