MEDICARE: IVAN L ROBINSON FNP-BC

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	363LF0000X	Family Nurse Practitioner	R197474	MD

General Provider Information

NPI Number	:	1295830586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN L ROBINSON FNP-BC

Provider Business Mailing Address
First Line	:	4201 30TH ST
Second Line	:
City	:	MT RAINER
State	:	MD
Zip	:	20712
Country	:	US
Telephone Number	:	202-652-0536
Fax Number	:	202-536-4369

Provider Business Practice Location Address
First Line	:	4201 30TH ST
Second Line	:
City	:	MOUNT RAINIER
State	:	MD
Zip	:	20712-1751
Country	:	US
Telephone Number	:	202-652-0536
Fax Number	:	202-536-4369

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/21/2022

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