Individual
DEATRA ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2912 LADD LN, LONGVIEW, TX 75604-1519
(903) 601-0513
Mailing address
2912 LADD LN, LONGVIEW, TX 75604-1519
(903) 601-0513
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
330883
TX
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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