MEDICARE: KENNETH ROBINSON

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	163WM0705X	Medical-Surgical Registered Nurse	297758	AZ

General Provider Information

NPI Number	:	1083547517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH ROBINSON

Provider Business Mailing Address
First Line	:	15741 W LUNDBERG ST
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-4343
Country	:	US
Telephone Number	:	320-219-2283
Fax Number	:

Provider Business Practice Location Address
First Line	:	15741 W LUNDBERG ST
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-4343
Country	:	US
Telephone Number	:	320-219-2283
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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