Provider Demographics
NPI:1578199980
Name:GUNTER, ROBIN MARION
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARION
Last Name:GUNTER
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 1:100 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ATHENS
Mailing Address - State:IL
Mailing Address - Zip Code:62264-1416
Mailing Address - Country:US
Mailing Address - Phone:618-409-2926
Mailing Address - Fax:
Practice Address - Street 1:100 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEW ATHENS
Practice Address - State:IL
Practice Address - Zip Code:62264-1416
Practice Address - Country:US
Practice Address - Phone:618-409-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020641363LF0000X
IL209.020641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily