MEDICARE: MISS TANDRA RENEE 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	164X00000X	Licensed Vocational Nurse	LPN.178625.MEDS-IV	OH

General Provider Information

NPI Number	:	1639743925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TANDRA RENEE ROBINSON

Provider Business Mailing Address
First Line	:	3982 ANDRUS CT W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1225
Country	:	US
Telephone Number	:	614-965-9562
Fax Number	:

Provider Business Practice Location Address
First Line	:	3982 ANDRUS CT W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1225
Country	:	US
Telephone Number	:	614-965-9562
Fax Number	:

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

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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