Provider Demographics
NPI:1477143113
Name:ROBINSON, MARY (DNPC, MSN/ED, BSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DNPC, MSN/ED, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 TORCH BRIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49676
Mailing Address - Country:US
Mailing Address - Phone:231-676-3428
Mailing Address - Fax:
Practice Address - Street 1:9370 TORCH BRIDGE CT NW
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:MI
Practice Address - Zip Code:49676-9490
Practice Address - Country:US
Practice Address - Phone:231-676-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217747163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management