Healthcare Provider Details

I. General information

NPI: 1588246003
Provider Name (Legal Business Name): ANGELA L ROBART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S WHITTEMORE ST
SAINT JOHNS MI
48879-1901
US

IV. Provider business mailing address

801 W SHARON RD
OAKLEY MI
48649-7702
US

V. Phone/Fax

Practice location:
  • Phone: 989-244-2413
  • Fax:
Mailing address:
  • Phone: 989-323-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704279277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: