Provider Demographics
NPI:1093589384
Name:ROBERTS, JANICE VANESSA
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:VANESSA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 PALMER AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4625
Mailing Address - Country:US
Mailing Address - Phone:914-740-5262
Mailing Address - Fax:
Practice Address - Street 1:2345 PALMER AVE APT 1D
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4625
Practice Address - Country:US
Practice Address - Phone:914-740-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse