=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487946968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN ALEXANDRA GULLEY CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2011
-----------------------------------------------------
Last Update Date | 09/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 GOODMAN ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-584-6927
-----------------------------------------------------
Fax | 513-584-1750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2830 VICTORY PKWY
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45206-1785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-245-3600
-----------------------------------------------------
Fax | 513-245-3672
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | COA.12322
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------