Individual
JESSICA LYNN GALLI ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
30 E APPLE ST STE 5254A, DAYTON, OH 45409
(937) 208-4200
(937) 208-4205
Mailing address
3170 KETTERING BLVD BLDG B3, MORAINE, OH 45439-1924
(937) 991-3191
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.005506RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102906
NCCPA
—
01
—
C0004672
MARYLAND BOARD OF PHYSICIANS
MD
Enumeration date
01/18/2012
Last updated
07/25/2018
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