Provider Demographics
NPI:1306042288
Name:ROBINSON, CHRISITNA NICOLE
Entity Type:Individual
Prefix:
First Name:CHRISITNA
Middle Name:NICOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:D
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0310
Mailing Address - Country:US
Mailing Address - Phone:769-798-4395
Mailing Address - Fax:
Practice Address - Street 1:204 ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5876
Practice Address - Country:US
Practice Address - Phone:769-798-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies