Provider Demographics
NPI:1689384109
Name:ROBERTSON, ERIKA LYNETTE
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:LYNETTE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-2922
Mailing Address - Country:US
Mailing Address - Phone:985-516-9930
Mailing Address - Fax:
Practice Address - Street 1:1106 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-2922
Practice Address - Country:US
Practice Address - Phone:985-516-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0000000000Medicaid