Provider Demographics
NPI:1114499555
Name:NETTLES, ROBIN M
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:NETTLES
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 1:8707 HELENA RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2732
Mailing Address - Country:US
Mailing Address - Phone:817-703-7344
Mailing Address - Fax:
Practice Address - Street 1:8707 HELENA RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-2732
Practice Address - Country:US
Practice Address - Phone:817-703-7344
Practice Address - Fax:205-988-9922
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty