Provider Demographics
NPI:1164543641
Name:ROBINSON, MARILYNN N (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARILYNN
Middle Name:N
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-05-04
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-273-7373
Mailing Address - Fax:314-362-6216
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG VASCULAR, STE 8A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-273-7373
Practice Address - Fax:314-362-6216
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO121246363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420203804Medicaid
ILENROLLEDMedicaid
MO833670181Medicaid