MEDICARE: ELIZABETH GRACE ROBINSON 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	363LA2100X	Acute Care Nurse Practitioner	208740	LA
2	363LA2100X	Acute Care Nurse Practitioner	431659	NY

General Provider Information

NPI Number	:	1285272641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GRACE ROBINSON NP

Provider Business Mailing Address
First Line	:	5717 LAKE SIDE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5509
Country	:	US
Telephone Number	:	318-423-1063
Fax Number	:

Provider Business Practice Location Address
First Line	:	5717 LAKE SIDE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5509
Country	:	US
Telephone Number	:	318-423-1063
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	08/09/2023

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