Provider Demographics
NPI:1609896604
Name:MYERS, ROBIN L (APRN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:MYERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71 ALLEN POND
Mailing Address - Street 2:SUITE 403
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:420 GROVE ST
Practice Address - Street 2:BRANDON INTERNAL MEDICINE
Practice Address - City:BRANDON
Practice Address - State:VT
Practice Address - Zip Code:05733-9062
Practice Address - Country:US
Practice Address - Phone:802-247-6305
Practice Address - Fax:802-247-6040
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT1010021213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007671Medicaid
VTP84532Medicare UPIN
VTP84532Medicare UPIN