Provider Demographics
NPI:1942637921
Name:POEDEL, ROBIN JULIANNE (PHD, RN, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:JULIANNE
Last Name:POEDEL
Suffix:
Gender:F
Credentials:PHD, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 N PORT WASHINGTON RD STE 325
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1000
Mailing Address - Country:US
Mailing Address - Phone:414-999-1099
Mailing Address - Fax:
Practice Address - Street 1:501 N PARK AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5034
Practice Address - Country:US
Practice Address - Phone:520-284-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218837363LF0000X
AZAP5204363LF0000X
WI9577363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095699Medicaid