Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036143948 | IL |
NPI | 1013350230 |
---|---|
Provider Name | Leanne J. Roberts |
First Address | Moline, IL 61265-6866 |
Second Address | Moline, IL 61265-6866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 17/08/2017 |