MEDICARE: MICHAEL JAMES ROBERTS STNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	400413421004	OH

General Provider Information

NPI Number	:	1073615761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES ROBERTS STNA

Provider Business Mailing Address
First Line	:	2661 CHELSEA DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-3916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 RANDOLPH RD
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-9345
Country	:	US
Telephone Number	:	330-628-8406
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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