Provider Demographics
NPI:1700303047
Name:ROBINSON, MICHELLE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-2646
Mailing Address - Country:US
Mailing Address - Phone:217-671-3900
Mailing Address - Fax:
Practice Address - Street 1:108 6TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-2646
Practice Address - Country:US
Practice Address - Phone:217-671-3900
Practice Address - Fax:217-671-3900
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker