Provider Demographics
NPI:1740924836
Name:REID-ROBINSON, RAQUEL CASSANDRA (CRNP)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:CASSANDRA
Last Name:REID-ROBINSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:CASSANDRA
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:644 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3504
Mailing Address - Country:US
Mailing Address - Phone:610-389-8697
Mailing Address - Fax:
Practice Address - Street 1:644 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3504
Practice Address - Country:US
Practice Address - Phone:610-389-8697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0011877363LF0000X
PASP025267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily