Provider Demographics
NPI:1043622111
Name:DRUSO, ROBERTA
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:DRUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3209
Mailing Address - Country:US
Mailing Address - Phone:216-789-7704
Mailing Address - Fax:
Practice Address - Street 1:1315 CLEARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3209
Practice Address - Country:US
Practice Address - Phone:216-789-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421409Medicaid