Provider Demographics
NPI:1083808844
Name:MYERS, ROBERTA JO (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JO
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HASKINS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1637
Mailing Address - Country:US
Mailing Address - Phone:419-373-7607
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:838 E WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3186
Practice Address - Country:US
Practice Address - Phone:419-372-2271
Practice Address - Fax:419-372-8010
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2822780Medicaid
OHNP24494Medicare PIN
OHH136752Medicare PIN