Provider Demographics
NPI:1336809177
Name:ROBINSON, GENNEICE
Entity Type:Individual
Prefix:
First Name:GENNEICE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MARTIN LUTHER KING JR BLVD APT 2205
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1708
Mailing Address - Country:US
Mailing Address - Phone:330-881-1974
Mailing Address - Fax:
Practice Address - Street 1:940 MARTIN LUTHER KING JR BLVD APT 2205
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1708
Practice Address - Country:US
Practice Address - Phone:330-881-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602344440521376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide