MEDICARE: ROBERT CENTEIO RN

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	163WG0000X	General Practice Registered Nurse	RN288372	GA

General Provider Information

NPI Number	:	1831865799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CENTEIO RN

Provider Business Mailing Address
First Line	:	2515 ORCHARD ST
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36869-6468
Country	:	US
Telephone Number	:	334-200-6635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 ORCHARD ST
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36869-6468
Country	:	US
Telephone Number	:	334-200-6635
Fax Number	:

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

Provider Enumeration Date	:	08/20/2021
Last Update Date	:	08/20/2021

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