MEDICARE: BRENDA ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1720634934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA ROBERTS

Provider Business Mailing Address
First Line	:	5906 HARRELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3534
Country	:	US
Telephone Number	:	313-452-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	5906 HARRELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3534
Country	:	US
Telephone Number	:	313-452-2755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “ BRENDA ROBERTS ” Practice Location

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