Provider Demographics
NPI:1134690142
Name:ROBINSON, DARRYL A (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1027
Mailing Address - Country:US
Mailing Address - Phone:509-232-5766
Mailing Address - Fax:
Practice Address - Street 1:12715 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1027
Practice Address - Country:US
Practice Address - Phone:509-232-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid