Provider Demographics
NPI:1669831228
Name:JANET GOBROGGE CNP LLC
Entity Type:Organization
Organization Name:JANET GOBROGGE CNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GOBROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:330-864-5100
Mailing Address - Street 1:3250 W MARKET ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3336
Mailing Address - Country:US
Mailing Address - Phone:330-864-5100
Mailing Address - Fax:
Practice Address - Street 1:3250 W MARKET ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3336
Practice Address - Country:US
Practice Address - Phone:330-864-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 10445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061215Medicaid