Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN-292216 | OH |
NPI | 1043226913 |
---|---|
Provider Name | Andrea D Roberts |
First Address | Cincinnati, OH 45206-2859 |
Second Address | West Chester, OH 45069-6542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2508601 | (05) | OH |
7801349700 | (05) | KY |