Provider Demographics
NPI:1194041095
Name:ROWELL, ROBERTA JO (RN, CNP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JO
Last Name:ROWELL
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:MS
Other - First Name:ROBERTA
Other - Middle Name:JO
Other - Last Name:ROWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:11100 EUCLID AVE # LK5006
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-2312
Mailing Address - Fax:216-201-5437
Practice Address - Street 1:11100 EUCLID AVE # MP1800
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-2312
Practice Address - Fax:216-201-5437
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 235202 COA1163W00000X
OHCOA 08718- NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse