Provider Demographics
NPI:1598204240
Name:ROBINSON, LORETTE (RPSGT,RST)
Entity Type:Individual
Prefix:
First Name:LORETTE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RPSGT,RST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17925 HALTON PARK DR
Mailing Address - Street 2:1E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6014
Mailing Address - Country:US
Mailing Address - Phone:360-510-5538
Mailing Address - Fax:
Practice Address - Street 1:17925 HALTON PARK DR
Practice Address - Street 2:1E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6014
Practice Address - Country:US
Practice Address - Phone:360-510-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9648246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other