Individual
NISA B ROBERTSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
Mailing address
107 S HIGH ST, ANTLERS, OK 74523-3818
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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