Provider Demographics
NPI:1598553976
Name:ROBERTS, MIKETTA L
Entity type:Individual
Prefix:
First Name:MIKETTA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 E 239TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2523
Mailing Address - Country:US
Mailing Address - Phone:216-269-8481
Mailing Address - Fax:
Practice Address - Street 1:831 E 239TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2523
Practice Address - Country:US
Practice Address - Phone:216-269-8481
Practice Address - Fax:216-269-8481
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant