Provider Demographics
NPI:1306404892
Name:MIKEALSON, ROBIN (RN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MIKEALSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:MIKEALSON-SPARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:501 PRIMROSE LN SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4043
Mailing Address - Country:US
Mailing Address - Phone:360-350-9391
Mailing Address - Fax:
Practice Address - Street 1:721 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5502
Practice Address - Country:US
Practice Address - Phone:253-207-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00156458163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse