Provider Demographics
NPI:1245088251
Name:ROBERTSONPETERS, JOI RENEE (CERTIFIED NURSE)
Entity type:Individual
Prefix:
First Name:JOI
Middle Name:RENEE
Last Name:ROBERTSONPETERS
Suffix:
Gender:F
Credentials:CERTIFIED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4217
Mailing Address - Country:US
Mailing Address - Phone:770-885-2211
Mailing Address - Fax:
Practice Address - Street 1:3441 ASHBY RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-4217
Practice Address - Country:US
Practice Address - Phone:770-885-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400391580804376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide