Provider Demographics
NPI:1649808031
Name:ROBINSON, ROBERTA JEAN
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:ROBINSON
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 1:100 E SIEBENTHALER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2428
Mailing Address - Country:US
Mailing Address - Phone:937-672-5341
Mailing Address - Fax:
Practice Address - Street 1:100 E SIEBENTHALER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2428
Practice Address - Country:US
Practice Address - Phone:937-672-5341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty