Individual
LACI RENAE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
212 AIRPORT ROAD W, FORT PAYNE, AL 35968
(256) 979-1250
Mailing address
212 AIRPORT RD W, FORT PAYNE, AL 35968-3335
(256) 979-1250
(256) 979-1251
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-132480
AL
363LF0000X
Family Nurse Practitioner
1-132480
AL
Other
Enumeration date
02/17/2021
Last updated
03/05/2026
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