Provider Demographics
NPI:1073911798
Name:ROBENOLT, JEANNE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNE MARIE
Middle Name:
Last Name:ROBENOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 WALTON WAY EXT
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4507
Mailing Address - Country:US
Mailing Address - Phone:706-364-1404
Mailing Address - Fax:706-364-1419
Practice Address - Street 1:3643 WALTON WAY EXT
Practice Address - Street 2:BUILDING 4
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4507
Practice Address - Country:US
Practice Address - Phone:706-364-1404
Practice Address - Fax:706-364-1419
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204148163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse