Healthcare Provider Details

I. General information

NPI: 1265690788
Provider Name (Legal Business Name): JAN ROBINSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WESTMINSTER AVE
BUFFALO NY
14215-1614
US

IV. Provider business mailing address

726 EXCHANGE ST
BUFFALO NY
14210-1484
US

V. Phone/Fax

Practice location:
  • Phone: 716-838-7460
  • Fax:
Mailing address:
  • Phone: 716-859-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number380590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: