Healthcare Provider Details

I. General information

NPI: 1053355024
Provider Name (Legal Business Name): LAURIE ROBINSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E MAIN ST
FLORENCE MS
39073-8407
US

IV. Provider business mailing address

PO BOX 530
FLORENCE MS
39073-0530
US

V. Phone/Fax

Practice location:
  • Phone: 601-845-6602
  • Fax: 601-845-6164
Mailing address:
  • Phone: 601-845-6602
  • Fax: 601-845-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR785118
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: