Individual
ROBERTA STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
442 W HIGH ST STE 3, BRYAN, OH 43506-1681
(419) 636-4517
(419) 636-6438
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-6013
(260) 458-5831
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.13364
OH
363LW0102X
Women's Health Nurse Practitioner
COA13364-NP
OH
Other
Enumeration date
09/30/2015
Last updated
03/17/2018
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