Healthcare Provider Details

I. General information

NPI: 1679097653
Provider Name (Legal Business Name): ROBIN HOGENMILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12502 WILLOWBROOK RD STE 300
CUMBERLAND MD
21502-6498
US

IV. Provider business mailing address

12502 WILLOWBROOK RD STE 300
CUMBERLAND MD
21502-6498
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-8787
  • Fax:
Mailing address:
  • Phone: 240-964-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR257088
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017478
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: