Healthcare Provider Details

I. General information

NPI: 1225667405
Provider Name (Legal Business Name): NICOLE ROBISON CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 HILL ST SE
ALBANY OR
97322-6711
US

IV. Provider business mailing address

1160 FRANKLIN ST
LEBANON OR
97355-3905
US

V. Phone/Fax

Practice location:
  • Phone: 541-609-1775
  • Fax:
Mailing address:
  • Phone: 541-609-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: