Healthcare Provider Details

I. General information

NPI: 1124362363
Provider Name (Legal Business Name): ROBIN A LEBOEUF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN BOWMAN

II. Dates (important events)

Enumeration Date: 11/10/2012
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3221 SPRING GARDEN ST APT 406
PHILADELPHIA PA
19104-3280
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax:
Mailing address:
  • Phone: 570-977-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN606751
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number079200-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP012567
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: