Provider Demographics
NPI:1407539141
Name:ROBERTS, LAKEIMA
Entity Type:Individual
Prefix:
First Name:LAKEIMA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 BOWMAN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7844
Mailing Address - Country:US
Mailing Address - Phone:409-549-2659
Mailing Address - Fax:
Practice Address - Street 1:4195 BOWMAN MEADOW DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7844
Practice Address - Country:US
Practice Address - Phone:409-549-2659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472811Medicaid