Healthcare Provider Details

I. General information

NPI: 1093911760
Provider Name (Legal Business Name): ROBYN NICOLE CHASE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 WILLOW CREEK RD
PRESCOTT AZ
86301-1641
US

IV. Provider business mailing address

PO BOX 11720
PRESCOTT AZ
86304-1720
US

V. Phone/Fax

Practice location:
  • Phone: 928-771-5470
  • Fax: 928-771-5471
Mailing address:
  • Phone: 928-771-5470
  • Fax: 928-771-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number00549
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number005449
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: