Healthcare Provider Details

I. General information

NPI: 1760106025
Provider Name (Legal Business Name): JAMES EARNEST ROBINSON III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 NW 11TH STREET
PENDLETON OR
97801-9783
US

IV. Provider business mailing address

PO BOX 469
HEPPNER OR
97836-0469
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-2536
  • Fax:
Mailing address:
  • Phone: 541-676-9161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200340550RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: