Provider Demographics
NPI:1295038586
Name:ROBINSON, JENNIFER LUCILLE
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LUCILLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LUCILLE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-322-3088
Mailing Address - Fax:248-322-4175
Practice Address - Street 1:42557 WOODWARD AVE
Practice Address - Street 2:STE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-333-1170
Practice Address - Fax:248-333-1175
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254436163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295023547OtherGROUP NPI TYPE II (MICHIGAN HEALTHCARE PROFESSIONALS, PC
MIMI4989OtherGROUP MEDICARE PIN