Healthcare Provider Details

I. General information

NPI: 1740245109
Provider Name (Legal Business Name): WILLIAM GEORGE ROBINSON JR. R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUTCHMANS LN
LOUISVILLE KY
40207-4714
US

IV. Provider business mailing address

431 INGLEWOOD DR
FAIRDALE KY
40118-8729
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-1010
  • Fax:
Mailing address:
  • Phone: 502-363-5296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1035876
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: