MEDICARE: VICTORIA ROBINSON LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002084276	VA

General Provider Information

NPI Number	:	1003169798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ROBINSON LPN

Provider Business Mailing Address
First Line	:	2116 MOUNTAIN VIEW TER SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-5510
Country	:	US
Telephone Number	:	540-293-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 GRANDIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-2305
Country	:	US
Telephone Number	:	540-342-9525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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