=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326531195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATRELLE ROBINSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2018
-----------------------------------------------------
Last Update Date | 06/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1986 CARTER RD
-----------------------------------------------------
City | FOLCROFT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19032-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-984-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1986 CARTER RD
-----------------------------------------------------
City | FOLCROFT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19032-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-984-9299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | TGPN029126
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------