Provider Demographics
NPI:1770197832
Name:ROBINSON, JENNA DANIELLE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:DANIELLE
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 1:1962 CABWAYLINGO PARK RD
Mailing Address - Street 2:
Mailing Address - City:DUNLOW
Mailing Address - State:WV
Mailing Address - Zip Code:25511-8034
Mailing Address - Country:US
Mailing Address - Phone:304-385-4615
Mailing Address - Fax:
Practice Address - Street 1:1962 CABWAYLINGO PARK RD
Practice Address - Street 2:
Practice Address - City:DUNLOW
Practice Address - State:WV
Practice Address - Zip Code:25511-8034
Practice Address - Country:US
Practice Address - Phone:304-385-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant