Provider Demographics
NPI:1043226913
Name:ROBERTS, ANDREA D (ARNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 VICTORY PKWY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2859
Mailing Address - Country:US
Mailing Address - Phone:513-872-7388
Mailing Address - Fax:513-872-7385
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SUITE 3200
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-872-7388
Practice Address - Fax:513-872-7385
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-292216363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7801349700Medicaid
OH2508601Medicaid
OH2508601Medicaid