Provider Demographics
NPI:1689888026
Name:ROBERTS, MICHELLE RENEE' (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE'
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MILLIKIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3448
Mailing Address - Country:US
Mailing Address - Phone:513-737-1207
Mailing Address - Fax:
Practice Address - Street 1:725 MILLIKIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3448
Practice Address - Country:US
Practice Address - Phone:513-737-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.117767164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse