Provider Demographics
NPI:1679150973
Name:ROBINSON, DESIREE ANGELIQUE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:ANGELIQUE
Last Name:ROBINSON
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 1:15409 N FRISCO RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-9477
Mailing Address - Country:US
Mailing Address - Phone:405-618-2611
Mailing Address - Fax:
Practice Address - Street 1:15409 N FRISCO RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-9477
Practice Address - Country:US
Practice Address - Phone:405-618-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider