Healthcare Provider Details

I. General information

NPI: 1235625294
Provider Name (Legal Business Name): SCOTT DAVID ROBINSON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 04/28/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ANNA MARSH LANE
BRATTLEBORO VT
05302-0530
US

IV. Provider business mailing address

2 PROCTOR PL APT 2
PROVIDENCE RI
02906-1620
US

V. Phone/Fax

Practice location:
  • Phone: 802-258-6796
  • Fax: 802-258-3788
Mailing address:
  • Phone: 774-263-4194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN59425
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN01843
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0134647
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: