Provider Demographics
NPI:1902229529
Name:ROBERTS, JO
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:
Last Name:ROBERTS
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 1:3900 COTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1616
Mailing Address - Country:US
Mailing Address - Phone:513-864-1470
Mailing Address - Fax:513-864-1491
Practice Address - Street 1:3900 COTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1616
Practice Address - Country:US
Practice Address - Phone:513-864-1470
Practice Address - Fax:513-864-1491
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN035802 MEDS164W00000X
OHPN035802164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse