Provider Demographics
NPI:1497125777
Name:ROBINS, GWEN BRAND (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GWEN
Middle Name:BRAND
Last Name:ROBINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-9715
Mailing Address - Country:US
Mailing Address - Phone:304-240-6520
Mailing Address - Fax:
Practice Address - Street 1:1355 EDWIN MILLER BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3703
Practice Address - Country:US
Practice Address - Phone:304-263-6753
Practice Address - Fax:304-263-8278
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant