Provider Demographics
NPI:1740541077
Name:ROBINSON, MARQUITA GABRAIEL (LPN)
Entity type:Individual
Prefix:MS
First Name:MARQUITA
Middle Name:GABRAIEL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GABBY
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4249 5TH AVE
Mailing Address - Street 2:APT C17
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3887
Mailing Address - Country:US
Mailing Address - Phone:337-292-3139
Mailing Address - Fax:337-475-8054
Practice Address - Street 1:4105 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4603
Practice Address - Country:US
Practice Address - Phone:337-475-8022
Practice Address - Fax:337-475-8054
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA270796164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse