Healthcare Provider Details

I. General information

NPI: 1447163654
Provider Name (Legal Business Name): PERNESHIA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 FORTUNE BLVD
SHILOH IL
62269-7358
US

IV. Provider business mailing address

1190 FORTUNE BLVD
SHILOH IL
62269-7358
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041445430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: