Provider Demographics
NPI:1699317032
Name:REEDY, ROBERTA (RN)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:REEDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MACFALLS WAY
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9387
Mailing Address - Country:US
Mailing Address - Phone:614-558-7523
Mailing Address - Fax:
Practice Address - Street 1:220 MACFALLS WAY
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9387
Practice Address - Country:US
Practice Address - Phone:614-558-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN459681163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management