Provider Demographics
NPI:1528030673
Name:ROBERTS, JANE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 PLEASURE PT W
Mailing Address - Street 2:
Mailing Address - City:MACEO
Mailing Address - State:KY
Mailing Address - Zip Code:42355-9710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2750
Practice Address - Country:US
Practice Address - Phone:812-554-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1045958367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00229918OtherRAILROAD MEDICARE PIN
KY000000308907OtherANTHEM BCBS PIN
KY74003989Medicaid
KY0699708Medicare ID - Type Unspecified
KY0572711Medicare ID - Type Unspecified
KY74003989Medicaid
P45236Medicare UPIN
INCC1100HMedicare ID - Type Unspecified