Provider Demographics
NPI:1922247741
Name:LAROCQUE, ROBIN G (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:G
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:NIAGARA UNIVERSITY
Mailing Address - State:NY
Mailing Address - Zip Code:14109-1153
Mailing Address - Country:US
Mailing Address - Phone:289-868-9588
Mailing Address - Fax:
Practice Address - Street 1:430 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1886
Practice Address - Country:US
Practice Address - Phone:716-856-2587
Practice Address - Fax:716-856-2608
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010203363LP0808X
NYF401697-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health