Healthcare Provider Details

I. General information

NPI: 1194107789
Provider Name (Legal Business Name): JESSICA MARIE ROBINSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PARK ST
MALONE NY
12953-1243
US

IV. Provider business mailing address

133 PARK ST
MALONE NY
12953-1243
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3000
  • Fax:
Mailing address:
  • Phone: 518-483-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: