Provider Demographics
NPI:1780760801
Name:STWORZYDLAK, ROBIN MANDY (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:MANDY
Last Name:STWORZYDLAK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 464 BOX 3342
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09226
Mailing Address - Country:DE
Mailing Address - Phone:01149972-990-7538
Mailing Address - Fax:
Practice Address - Street 1:USAHC SCHWEINFURT MEDDAC
Practice Address - Street 2:CMR 457
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09033
Practice Address - Country:DE
Practice Address - Phone:01149972-196-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475234-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse