Healthcare Provider Details

I. General information

NPI: 1659058691
Provider Name (Legal Business Name): ELAINE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7527 EPHRIAM HILL ROAD
FORT TOTTEN ND
58335
US

IV. Provider business mailing address

PO BOX 88
FORT TOTTEN ND
58335-0088
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-4285
  • Fax: 701-766-1229
Mailing address:
  • Phone: 701-766-4285
  • Fax: 701-766-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: