MEDICARE: DINA ROBINSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1447908082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA ROBINSON

Provider Business Mailing Address
First Line	:	5214 BOWSER AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-5128
Country	:	US
Telephone Number	:	260-702-1521
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 BOWSER AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-5128
Country	:	US
Telephone Number	:	260-702-1521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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Directions to “ DINA ROBINSON ” Practice Location

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