1043226913 NPI number — ANDREA D ROBERTS ARNP

Table of content: ANDREA D ROBERTS ARNP (NPI 1043226913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043226913 NPI number — ANDREA D ROBERTS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
ANDREA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043226913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2368 VICTORY PKWY
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-872-7388
Provider Business Mailing Address Fax Number:
513-872-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 UNIVERSITY CT
Provider Second Line Business Practice Location Address:
SUITE 3200
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-6542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-872-7388
Provider Business Practice Location Address Fax Number:
513-872-7385
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  RN-292216 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7801349700 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2508601 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com