Healthcare Provider Details

I. General information

NPI: 1144509605
Provider Name (Legal Business Name): JERICA AMBER ROBINSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OAKBRIDGE CT
MADISON WI
53717-1600
US

IV. Provider business mailing address

6 OAKBRIDGE CT
MADISON WI
53717-1600
US

V. Phone/Fax

Practice location:
  • Phone: 608-225-6810
  • Fax:
Mailing address:
  • Phone: 608-225-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number171396-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: