Healthcare Provider Details

I. General information

NPI: 1881360469
Provider Name (Legal Business Name): ROBIN BACHKOSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S COLLEGE RD
WILMINGTON NC
28403-3201
US

IV. Provider business mailing address

331 CAMPUS CV APT 201-2
WILMINGTON NC
28403-3103
US

V. Phone/Fax

Practice location:
  • Phone: 910-962-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: