Healthcare Provider Details

I. General information

NPI: 1346163516
Provider Name (Legal Business Name): ALYSSA LEANN ROBERTSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E STATE ST
COLUMBUS OH
43215-4312
US

IV. Provider business mailing address

6764 BENNELL DR
REYNOLDSBURG OH
43068-4090
US

V. Phone/Fax

Practice location:
  • Phone: 614-365-5000
  • Fax:
Mailing address:
  • Phone: 541-261-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.553851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: