Provider Demographics
NPI:1982421947
Name:GLON, ROBERTA (RN)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:GLON
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 1:4477 WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9528
Mailing Address - Country:US
Mailing Address - Phone:614-565-2606
Mailing Address - Fax:
Practice Address - Street 1:220 W MARKET ST STE 120
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4820
Practice Address - Country:US
Practice Address - Phone:614-565-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.407285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse