Provider Demographics
NPI:1245661503
Name:ROBERTS, JANINE L (PNP)
Entity type:Individual
Prefix:MS
First Name:JANINE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:L
Other - Last Name:CONNERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:2033 E WARNER RD #109
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284
Mailing Address - Country:US
Mailing Address - Phone:602-254-0390
Mailing Address - Fax:480-907-5014
Practice Address - Street 1:2033 E WARNER RD #109
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284
Practice Address - Country:US
Practice Address - Phone:602-254-0390
Practice Address - Fax:480-907-5014
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN053288163W00000X
AZAP6859363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse