Healthcare Provider Details

I. General information

NPI: 1235388232
Provider Name (Legal Business Name): MARK WILLIAM ROBINSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BRUCE ST SUITE 500
YREKA CA
96097-3474
US

IV. Provider business mailing address

475 BRUCE ST SUITE 500
YREKA CA
96097-3474
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-3507
  • Fax:
Mailing address:
  • Phone: 530-842-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number000004011
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number000352350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: