Healthcare Provider Details

I. General information

NPI: 1407815210
Provider Name (Legal Business Name): ROBIN ELAINE SQUELLATI WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

IV. Provider business mailing address

5700 ARNOLD ST
TINKER AFB OK
73145-8105
US

V. Phone/Fax

Practice location:
  • Phone: 405-736-2156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0001126040
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: