Provider Demographics
NPI:1184843542
Name:DODRILL, ROBYN DIANE (LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBYN
Middle Name:DIANE
Last Name:DODRILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 BLACK SEA RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-9689
Mailing Address - Country:US
Mailing Address - Phone:440-294-2123
Mailing Address - Fax:
Practice Address - Street 1:2836 BLACK SEA RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-9689
Practice Address - Country:US
Practice Address - Phone:440-294-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119892164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2681496Medicaid