Provider Demographics
NPI:1124517578
Name:ROBERTS, DELANA RUTH
Entity type:Individual
Prefix:MRS
First Name:DELANA
Middle Name:RUTH
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 1:503 W AURORA VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:TX
Mailing Address - Zip Code:76078-4650
Mailing Address - Country:US
Mailing Address - Phone:817-504-2551
Mailing Address - Fax:
Practice Address - Street 1:503 W AURORA VISTA TRL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:TX
Practice Address - Zip Code:76078-4650
Practice Address - Country:US
Practice Address - Phone:817-504-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant