Healthcare Provider Details

I. General information

NPI: 1710546205
Provider Name (Legal Business Name): WANDA LYNN ROBINSON PHD, APRN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

IV. Provider business mailing address

121 E FEDERAL ST
SHAWNEE OK
74804-3703
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1491
  • Fax:
Mailing address:
  • Phone: 405-623-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberROO46347
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: