Provider Demographics
NPI:1407532724
Name:ROBERTS, BIANCA LUCINDA
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:LUCINDA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3462
Mailing Address - Country:US
Mailing Address - Phone:681-265-5082
Mailing Address - Fax:
Practice Address - Street 1:306 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3462
Practice Address - Country:US
Practice Address - Phone:681-265-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant