Provider Demographics
NPI:1437209285
Name:ROBERTS, GAYLE ANN (CNP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9274
Mailing Address - Country:US
Mailing Address - Phone:740-439-5780
Mailing Address - Fax:
Practice Address - Street 1:123 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6606
Practice Address - Country:US
Practice Address - Phone:330-832-2229
Practice Address - Fax:330-833-4247
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN137662363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2329653Medicaid