Provider Demographics
NPI:1710586508
Name:ROBERTSON, JOAN A
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:A
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 BURNING TREE LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-1716
Mailing Address - Country:US
Mailing Address - Phone:513-515-4302
Mailing Address - Fax:
Practice Address - Street 1:3032 BURNING TREE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-1716
Practice Address - Country:US
Practice Address - Phone:513-515-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide