Provider Demographics
NPI:1073009775
Name:ROBINSON, CHARLEEN NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:NICOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHARLEEN
Other - Middle Name:NICOLE
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4 NORTHRIDGE DR STE 118
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8484
Mailing Address - Country:US
Mailing Address - Phone:304-473-1440
Mailing Address - Fax:304-473-1441
Practice Address - Street 1:4 NORTHRIDGE DR STE 118
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8484
Practice Address - Country:US
Practice Address - Phone:304-473-1440
Practice Address - Fax:304-473-1441
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily