Healthcare Provider Details

I. General information

NPI: 1629642459
Provider Name (Legal Business Name): SHANICE A ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 KIRBY PKWY STE 1
MEMPHIS TN
38138-3667
US

IV. Provider business mailing address

1811 KIRBY PKWY STE 1
MEMPHIS TN
38138-3667
US

V. Phone/Fax

Practice location:
  • Phone: 901-275-8321
  • Fax:
Mailing address:
  • Phone: 901-275-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number47335
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: