Provider Demographics
NPI:1790021079
Name:ROBERSON, TERRI (LPN)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:ROBERSON
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 1:2103 MENDENHALL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45064-9430
Mailing Address - Country:US
Mailing Address - Phone:513-267-6463
Mailing Address - Fax:
Practice Address - Street 1:2103 MENDENHALL RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45064-9430
Practice Address - Country:US
Practice Address - Phone:513-267-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN098719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse