Healthcare Provider Details

I. General information

NPI: 1902840267
Provider Name (Legal Business Name): ROBIN ANNETTE WHITMORE CHN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MISSOURI AVE MCXP-CCS-CR
FORT LEONARD WOOD MO
65473-8952
US

IV. Provider business mailing address

126 MISSOURI AVE MCXP-CCS-CR
FORT LEONARD WOOD MO
65473-8952
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0417
  • Fax: 573-596-0524
Mailing address:
  • Phone: 573-596-0417
  • Fax: 573-596-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number83575
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: