Healthcare Provider Details

I. General information

NPI: 1306369731
Provider Name (Legal Business Name): ELIZABETH ROEBUCK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 GILBERT AVE
CINCINNATI OH
45206-1210
US

IV. Provider business mailing address

421 S CAMPUS AVE
OXFORD OH
45056-2487
US

V. Phone/Fax

Practice location:
  • Phone: 513-815-4475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020965
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: