Provider Demographics
NPI:1265767776
Name:WOODMAN, ROBERTA JEAN (RN, ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JEAN
Last Name:WOODMAN
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Gender:F
Credentials:RN, ANP-BC
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Mailing Address - Street 1:3755 ORANGE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4426
Mailing Address - Country:US
Mailing Address - Phone:216-593-0030
Mailing Address - Fax:216-593-0031
Practice Address - Street 1:3755 ORANGE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4426
Practice Address - Country:US
Practice Address - Phone:216-593-0030
Practice Address - Fax:216-593-0031
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2012-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN137751/NP10461363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3012395Medicaid
OHNP84871Medicare PIN