Healthcare Provider Details

I. General information

NPI: 1972322964
Provider Name (Legal Business Name): CHARLES CHRISTOPHER ROBINSON PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2872 SE BRENT ST
HILLSBORO OR
97123-5236
US

IV. Provider business mailing address

2872 SE BRENT ST
HILLSBORO OR
97123-5236
US

V. Phone/Fax

Practice location:
  • Phone: 971-245-0241
  • Fax:
Mailing address:
  • Phone: 971-245-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000000
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: