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NPI Code Detail

MEDICARE: CHANELLE VICKNAIR ROBINSON FNP-C

MEDICARE: CHANELLE VICKNAIR ROBINSON FNP-C
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
1363LF0000XFamily Nurse Practitioner71007112AIN

General Provider Information

NPI Number : 1033647698
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANELLE VICKNAIR ROBINSON FNP-C
Provider Business Mailing Address
First Line : 5417 BRASSIE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46235-6079
Country : US
Telephone Number : 504-250-4054
Fax Number :
Provider Business Practice Location Address
First Line : 9805 GEIST CROSSING DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-4819
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2017
Last Update Date : 05/26/2017

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