Provider Demographics
NPI:1114670783
Name:ROBISON, ANGELA M (W000105223)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:ROBISON
Suffix:
Gender:F
Credentials:W000105223
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:BINDRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:W000105223
Mailing Address - Street 1:63140 BRITTA ST STE D104
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5738
Mailing Address - Country:US
Mailing Address - Phone:888-237-7778
Mailing Address - Fax:
Practice Address - Street 1:63140 BRITTA ST STE D104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5738
Practice Address - Country:US
Practice Address - Phone:888-237-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105223172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000105223Medicaid