Provider Demographics
NPI:1962624627
Name:ANDREWS, ROBERTA LYNNE
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNNE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:LYNNE
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3850 W STATE ROUTE 571
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-7502
Mailing Address - Country:US
Mailing Address - Phone:937-270-3226
Mailing Address - Fax:
Practice Address - Street 1:3850 W STATE ROUTE 571
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-7502
Practice Address - Country:US
Practice Address - Phone:937-270-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 293583163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2704587Medicaid