Healthcare Provider Details

I. General information

NPI: 1801941331
Provider Name (Legal Business Name): ROBIN SUPPLEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 NE RIDDELL RD
BREMERTON WA
98310-3028
US

IV. Provider business mailing address

10140 NE ROBERTS RD
BAINBRIDGE ISLAND WA
98110-3383
US

V. Phone/Fax

Practice location:
  • Phone: 360-373-6827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberAP30006374
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: