Healthcare Provider Details

I. General information

NPI: 1770433617
Provider Name (Legal Business Name): GBERRAH ROY IDRISS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 HARMON AVE
COLUMBUS OH
43223-2203
US

IV. Provider business mailing address

11361 N 99TH AVE STE 402
PEORIA AZ
85345-5459
US

V. Phone/Fax

Practice location:
  • Phone: 614-599-4406
  • Fax: 614-358-4201
Mailing address:
  • Phone: 602-650-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0041946
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.470931
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: