Provider Demographics
NPI:1629568001
Name:ROBERTS, JANAE NOELLE
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:NOELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:NOELLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 N 3RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5550
Mailing Address - Country:US
Mailing Address - Phone:740-349-7511
Mailing Address - Fax:740-522-4263
Practice Address - Street 1:15 N 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5550
Practice Address - Country:US
Practice Address - Phone:740-349-7511
Practice Address - Fax:740-522-4263
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty