Provider Demographics
NPI:1902416712
Name:BRASS, ROBIN LYNN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:BRASS
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 1:200 STRAWBERRY LANE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704
Mailing Address - Country:US
Mailing Address - Phone:304-359-7875
Mailing Address - Fax:
Practice Address - Street 1:200 STRAWBERRY LANE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704
Practice Address - Country:US
Practice Address - Phone:304-359-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant