Provider Demographics
NPI:1417550351
Name:ROBICHAUX, WYLENA JANELL (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:WYLENA
Middle Name:JANELL
Last Name:ROBICHAUX
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:MISS
Other - First Name:WYLENA
Other - Middle Name:JANELL
Other - Last Name:DEES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1714 CAROLINA PL SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7464
Mailing Address - Country:US
Mailing Address - Phone:904-214-6104
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse