Provider Demographics
NPI:1013364447
Name:BOONE, ROBIN (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6150 OAK TREE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6917
Mailing Address - Country:US
Mailing Address - Phone:800-897-9177
Mailing Address - Fax:800-470-8713
Practice Address - Street 1:717 GREEN VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2155
Practice Address - Country:US
Practice Address - Phone:800-897-9177
Practice Address - Fax:800-470-8713
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC206596163W00000X
NC5008579363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse