Active NPI
Ethel Lee Roberson, RN
- Administrator Registered Nurse
- Fort Irwin, CA
National Provider Identifier
1467518639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Administrator Registered Nurse
- License
- 224780
- Practice address
- 3942 Bitter Springs Dr
Fort Irwin, CA 92310-1597 - Phone
- (760) 900-2338
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Administrator Registered Nurse | 163WA2000X | 224780 | TX | Primary |
Addresses
Primary practice location
3942 Bitter Springs Dr
Fort Irwin, CA 92310-1597
Mailing address
4TH and Inner Loop
Fort Irwin, CA 92310-1597
Phone (760) 380-3190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 224780 | TX | MD | Administrator Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467518639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4TH AND INNER LOOP",
"city": "FORT IRWIN",
"state": "CA",
"postal_code": "923101597",
"telephone_number": "760-380-3190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3942 BITTER SPRINGS DR",
"city": "FORT IRWIN",
"state": "CA",
"postal_code": "923101597",
"telephone_number": "760-900-2338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "ETHEL",
"middle_name": "LEE",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WA2000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Administrator",
"state": "TX",
"license": "224780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Irwin, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.