MEDICARE: ELIZABETH NICOLE 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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1700661246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NICOLE ROBINSON

Provider Business Mailing Address
First Line	:	758 W WYNSTONE DR APT 306
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-8227
Country	:	US
Telephone Number	:	417-316-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	758 W WYNSTONE DR APT 306
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-8227
Country	:	US
Telephone Number	:	417-316-3115
Fax Number	:

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

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	08/30/2023

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