Individual
MARK ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 WYOMING ST, DAYTON, OH 45409-2731
(937) 223-4461
(937) 449-7603
Mailing address
1846 SPINDLETOP LN, DAYTON, OH 45458-6501
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
PN151753-M-IV
OH
363L00000X
Nurse Practitioner
APRN.CNP.0027441
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0027441
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0424687
—
OH
Enumeration date
11/23/2013
Last updated
10/14/2024
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