Healthcare Provider Details

I. General information

NPI: 1386634327
Provider Name (Legal Business Name): LYNN MARIE ROBERTS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S GRANT AVE 7TH FL
COLUMBUS OH
43215
US

IV. Provider business mailing address

1299 OLENTANGY RIVER RD STE 103
COLUMBUS OH
43212-3135
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-9000
  • Fax:
Mailing address:
  • Phone: 614-566-4278
  • Fax: 614-566-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA155215
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.06760
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: