Basic Information
| Provider Information | |||||||||
| NPI: | 1700934924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBLIN | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5829 DONN RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430559634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407455634 | ||||||||
| FaxNumber: | 7407889226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1980 TAMARACK RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430551363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407889220 | ||||||||
| FaxNumber: | 7407889226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 268074 | OH | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.