Individual
CYNTHIA LANEALE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-7728
(317) 274-2940
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
10003890A
IN
363AM0700X
Medical Physician Assistant
2440
OK
363AS0400X
Surgical Physician Assistant
Primary
10003890A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074790133
MEDICARE
IN
Enumeration date
01/06/2015
Last updated
02/09/2023
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