Provider Demographics
NPI:1508323882
Name:ELDER-ROBINSON, RENITA JON (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:RENITA
Middle Name:JON
Last Name:ELDER-ROBINSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:RENITA
Other - Middle Name:JON
Other - Last Name:ELDER-ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:34564 BLACKFOOT ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2725
Mailing Address - Country:US
Mailing Address - Phone:248-910-1814
Mailing Address - Fax:
Practice Address - Street 1:22990 KING RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1025
Practice Address - Country:US
Practice Address - Phone:248-910-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235476363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health