Provider Demographics
NPI:1700934924
Name:GIBLIN, ROBERTA SUE (RNFA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:SUE
Last Name:GIBLIN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5829 DONN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9634
Mailing Address - Country:US
Mailing Address - Phone:740-745-5634
Mailing Address - Fax:740-788-9226
Practice Address - Street 1:1980 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1363
Practice Address - Country:US
Practice Address - Phone:740-788-9220
Practice Address - Fax:740-788-9226
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH268074163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant