Healthcare Provider Details

I. General information

NPI: 1982572335
Provider Name (Legal Business Name): MRS. ROBIN GRAY ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16207 POINTER RIDGE DR
BOWIE MD
20716-1853
US

IV. Provider business mailing address

16207 POINTER RIDGE DR
BOWIE MD
20716-1853
US

V. Phone/Fax

Practice location:
  • Phone: 619-977-0502
  • Fax:
Mailing address:
  • Phone: 619-977-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-68447
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: