Healthcare Provider Details

I. General information

NPI: 1407841323
Provider Name (Legal Business Name): MS. MARY E ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST
MAXWELL AFB AL
36112
US

IV. Provider business mailing address

402 EAST DR
MONTGOMERY AL
36113-1205
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5143
  • Fax: 334-953-8296
Mailing address:
  • Phone: 850-819-2059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number54446
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: