Provider Demographics
NPI:1255921177
Name:ROBERTS, JOEL (NP)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ARNEY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9472
Mailing Address - Country:US
Mailing Address - Phone:503-902-3900
Mailing Address - Fax:
Practice Address - Street 1:105 ARNEY RD STE 130
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9472
Practice Address - Country:US
Practice Address - Phone:503-902-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202010988NP363LP2300X
OR202010988NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner