Healthcare Provider Details

I. General information

NPI: 1790098028
Provider Name (Legal Business Name): BETH ANN ROBINSON NIC ADVANCED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 TACOMA AVE S APT 902
TACOMA WA
98402-2570
US

IV. Provider business mailing address

220 TACOMA AVE S APT 902
TACOMA WA
98402-2570
US

V. Phone/Fax

Practice location:
  • Phone: 509-999-3420
  • Fax:
Mailing address:
  • Phone: 509-999-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number601441110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: