Provider Demographics
NPI:1629220728
Name:WILLOUGHBY, ROBIN C (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:C
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:C
Other - Last Name:DEGEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-8401
Mailing Address - Fax:
Practice Address - Street 1:897 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1029
Practice Address - Country:US
Practice Address - Phone:207-564-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA123056367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400126873Medicare PIN