Provider Demographics
NPI:1679184774
Name:FIFITA, ROBIN LEE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:FIFITA
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 1:2844 NW ARNOLD WAY
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5206
Mailing Address - Country:US
Mailing Address - Phone:541-745-4922
Mailing Address - Fax:
Practice Address - Street 1:2844 NW ARNOLD WAY
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5206
Practice Address - Country:US
Practice Address - Phone:541-745-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000004241374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula