Provider Demographics
NPI:1780012245
Name:ANDERSON, ROBIN (NP-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 WILLOWCREEK RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5013
Mailing Address - Country:US
Mailing Address - Phone:219-763-3636
Mailing Address - Fax:219-764-2479
Practice Address - Street 1:3207 WILLOWCREEK RD STE A
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5013
Practice Address - Country:US
Practice Address - Phone:219-763-3636
Practice Address - Fax:219-764-2479
Is Sole Proprietor?:No
Enumeration Date:2013-10-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28161257A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily