Provider Demographics
NPI:1558839944
Name:NADELL, ROBIN ROBERTTA
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ROBERTTA
Last Name:NADELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9776
Mailing Address - Country:US
Mailing Address - Phone:989-313-5171
Mailing Address - Fax:
Practice Address - Street 1:2151 WHITE ST
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9776
Practice Address - Country:US
Practice Address - Phone:989-313-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician