Individual
ROBERTA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2700 STEWART PARKWAY, ANNEX B, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Mailing address
272 MEDICAL LOOP, SUITE E, ROSEBURG, OR 97471
(541) 440-3532
(541) 440-3554
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
200040188RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500665845
—
OR
Enumeration date
10/10/2008
Last updated
10/22/2015
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