Provider Demographics
NPI:1679247423
Name:ROBLES, ANN MARIE (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:ROBLES
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:CROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:995 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1535
Mailing Address - Country:US
Mailing Address - Phone:248-004-0872
Mailing Address - Fax:
Practice Address - Street 1:5875 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4937
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:815-381-7498
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR14205371652OtherILLINOIS DRIVERS LICENSE