Provider Demographics
NPI:1184821027
Name:ROBINSON, BERNICE A (RN,NU,DT)
Entity Type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RN,NU,DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-7368
Mailing Address - Country:US
Mailing Address - Phone:708-333-6349
Mailing Address - Fax:708-333-6349
Practice Address - Street 1:16001 MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4920
Practice Address - Country:US
Practice Address - Phone:708-333-6349
Practice Address - Fax:708-333-6349
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBR80170400P133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist