Provider Demographics
NPI:1629704903
Name:FANCHER, ROBIN E
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:FANCHER
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 1:1895 AMELIA WAY
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-7415
Mailing Address - Country:US
Mailing Address - Phone:937-470-3191
Mailing Address - Fax:
Practice Address - Street 1:1895 AMELIA WAY
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-7415
Practice Address - Country:US
Practice Address - Phone:937-470-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450501Medicaid