Healthcare Provider Details

I. General information

NPI: 1700934924
Provider Name (Legal Business Name): ROBERTA SUE GIBLIN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 TAMARACK RD
NEWARK OH
43055-1363
US

IV. Provider business mailing address

5829 DONN RD
NEWARK OH
43055-9634
US

V. Phone/Fax

Practice location:
  • Phone: 740-788-9220
  • Fax: 740-788-9226
Mailing address:
  • Phone: 740-745-5634
  • Fax: 740-788-9226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number268074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: