Healthcare Provider Details

I. General information

NPI: 1164735429
Provider Name (Legal Business Name): KIMBERLY L. ROBINSON N.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY SUITE 622 MURDOCK
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY SUITE 622 MURDOCK
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5068
  • Fax:
Mailing address:
  • Phone: 312-942-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209-008002
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: