Healthcare Provider Details

I. General information

NPI: 1881644771
Provider Name (Legal Business Name): TERRY ALLEN ROBICHAUD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10561 JEFFREYS ST STE 211
HENDERSON NV
89052
US

IV. Provider business mailing address

10561 JEFFREYS ST STE 211
HENDERSON NV
89052-4268
US

V. Phone/Fax

Practice location:
  • Phone: 702-990-4530
  • Fax:
Mailing address:
  • Phone: 702-990-4530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number444
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number444
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: