Healthcare Provider Details

I. General information

NPI: 1982153946
Provider Name (Legal Business Name): ROBIN HATHAWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN BINGHAM RN

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NE INDEPENDENCE AVE
LEES SUMMIT MO
64086-5544
US

IV. Provider business mailing address

1401 SW 8TH TER
LEES SUMMIT MO
64081-2516
US

V. Phone/Fax

Practice location:
  • Phone: 816-581-5852
  • Fax: 816-347-3046
Mailing address:
  • Phone: 913-231-7105
  • Fax: 816-347-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number054062
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number163W0000X
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: