Provider Demographics
NPI:1790722924
Name:UNDERWOOD, ROBIN J (CRNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:SUSANNE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:251-607-9761
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2043
Practice Address - Country:US
Practice Address - Phone:251-990-9500
Practice Address - Fax:251-990-9501
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1035842363L00000X
AL1-035842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051505706Medicaid
AL0515-05708OtherBLUE CROSS BLUE SHIELD
AL051505706Medicare ID - Type Unspecified
AL051505706Medicaid