Healthcare Provider Details

I. General information

NPI: 1538143839
Provider Name (Legal Business Name): ROBYN A CONNOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 MEDICAL CENTER DR NICU
ROCKVILLE MD
20850-3357
US

IV. Provider business mailing address

4991 LAKE BROOK DR SUITE 300
GLEN ALLEN VA
23060-9290
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-6392
  • Fax:
Mailing address:
  • Phone: 888-627-4702
  • Fax: 804-253-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR065872
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: