Provider Demographics
NPI:1952505869
Name:ROBINSON, MONIQUE MARIE (RN,NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:MARIE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RN,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4447
Mailing Address - Country:US
Mailing Address - Phone:765-213-2234
Mailing Address - Fax:765-282-5231
Practice Address - Street 1:503 S TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4447
Practice Address - Country:US
Practice Address - Phone:765-213-2234
Practice Address - Fax:765-282-5231
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28109346A163W00000X
IN71002403A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000523077OtherBC/BS
IN28109346AOtherRN LICENSE
IN200863010AMedicaid
IN71002403AOtherNP LICENSE
IN28109346AOtherRN LICENSE
IN200863010AMedicaid