Provider Demographics
NPI:1578644829
Name:ROBERTS, REBECCA ANNE (RN, CNS, CWOCN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, CNS, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 CORYDON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3514
Mailing Address - Country:US
Mailing Address - Phone:216-844-2902
Mailing Address - Fax:216-844-3850
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:MAILSTOP WEARN 5057
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-2902
Practice Address - Fax:216-844-3850
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-122995364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical