MEDICARE: MRS. LISA A ROBINETTE AGNP-C

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	LE-00032052	OH
2	363LG0600X	Gerontology Nurse Practitioner	LE-00032052	OH

General Provider Information

NPI Number	:	1710505110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA A ROBINETTE AGNP-C

Provider Business Mailing Address
First Line	:	5050 GLENCROSSING WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3360
Country	:	US
Telephone Number	:	513-813-4311
Fax Number	:	513-810-3733

Provider Business Practice Location Address
First Line	:	5050 GLENCROSSING WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3360
Country	:	US
Telephone Number	:	513-813-4311
Fax Number	:	513-810-3733

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

Provider Enumeration Date	:	07/12/2020
Last Update Date	:	05/09/2022

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