Individual
MRS. CONNIE SUE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2953 LINDALE AVE, DAYTON, OH 45414-5520
(937) 657-7015
Mailing address
2953 LINDALE AVE, DAYTON, OH 45414-5520
(937) 657-7015
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
376J00000X
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2883456
ODJFS MEDICAID PROVIDER NUMBER
OH
Enumeration date
12/06/2012
Last updated
12/06/2012
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