Provider Demographics
NPI:1598193666
Name:NATHANIEL, ROBINSON
Entity Type:Individual
Prefix:
First Name:ROBINSON
Middle Name:
Last Name:NATHANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18949 MARSH LN
Mailing Address - Street 2:# 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-2100
Mailing Address - Country:US
Mailing Address - Phone:972-693-6858
Mailing Address - Fax:
Practice Address - Street 1:18949 MARSH LN
Practice Address - Street 2:# 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-2100
Practice Address - Country:US
Practice Address - Phone:972-693-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230566313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility