Healthcare Provider Details

I. General information

NPI: 1245661503
Provider Name (Legal Business Name): JANINE L ROBERTS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANINE L. CONNERS PNP

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 E WARNER RD #109
TEMPE AZ
85284
US

IV. Provider business mailing address

2033 E WARNER RD #109
TEMPE AZ
85284
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-0390
  • Fax: 480-907-5014
Mailing address:
  • Phone: 602-254-0390
  • Fax: 480-907-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP6859
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN053288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: