MEDICARE: ROBIN MICHELLE DONALDSON NP

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	363L00000X	Nurse Practitioner	2020035581	MO

General Provider Information

NPI Number	:	1073106191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN MICHELLE DONALDSON NP

Provider Business Mailing Address
First Line	:	11155 DUNN RD STE 201N
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-741-1400
Fax Number	:	314-741-0175

Provider Business Practice Location Address
First Line	:	11155 DUNN RD STE 201N
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6149
Country	:	US
Telephone Number	:	314-741-1400
Fax Number	:	314-741-0175

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

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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