Provider Demographics
NPI:1871789982
Name:ROBERTS, RANAE M (RN, NP,)
Entity type:Individual
Prefix:
First Name:RANAE
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, NP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 UNION DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011
Mailing Address - Country:US
Mailing Address - Phone:515-294-5801
Mailing Address - Fax:
Practice Address - Street 1:2647 UNION DRIVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011
Practice Address - Country:US
Practice Address - Phone:515-294-5801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG093016363LP0808X
CA20669363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health