Provider Demographics
NPI:1336586262
Name:PORT, ROBYN SUZANNE (LPN)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:SUZANNE
Last Name:PORT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 DANAMARIE LN
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5609
Mailing Address - Country:US
Mailing Address - Phone:516-298-6005
Mailing Address - Fax:
Practice Address - Street 1:17 DANAMARIE LN
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5609
Practice Address - Country:US
Practice Address - Phone:516-298-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse