Healthcare Provider Details

I. General information

NPI: 1962746198
Provider Name (Legal Business Name): MAXIE L ROBINSON BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2865 LYNCREST DR
NASHVILLE TN
37214-3516
US

IV. Provider business mailing address

2865 LYNCREST DR
NASHVILLE TN
37214-3516
US

V. Phone/Fax

Practice location:
  • Phone: 615-618-0890
  • Fax:
Mailing address:
  • Phone: 615-618-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number0
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: