Provider Demographics
NPI:1558434159
Name:SUMNER, ROBIN LINCOLN (PA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LINCOLN
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90605
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27675-0605
Mailing Address - Country:US
Mailing Address - Phone:919-881-8295
Mailing Address - Fax:919-676-6769
Practice Address - Street 1:876 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2071
Practice Address - Country:US
Practice Address - Phone:951-412-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102542208D00000X
363AS0400X
CA62616363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ54835Medicare UPIN
NC2764584Medicare PIN
NC2764584AMedicare PIN