Provider Demographics
NPI:1578656757
Name:ROBERTS, JANA R HODGES (RN)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:R HODGES
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-0210
Mailing Address - Country:US
Mailing Address - Phone:304-586-0453
Mailing Address - Fax:
Practice Address - Street 1:300 HARBOUR LN
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9663
Practice Address - Country:US
Practice Address - Phone:304-562-3610
Practice Address - Fax:304-562-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35338163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9702082000Medicaid