Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | COA.16636-NP | OH |
NPI | 1043602675 |
---|---|
Provider Name | William Roberts |
First Address | Cleveland, OH 44111-5612 |
Second Address | Cleveland, OH 44111-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2015 |
Last Update Date | 18/02/2015 |