Provider Demographics
NPI:1881360279
Name:ROBINSON-WHIPPLE, GRACE IRENE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:IRENE
Last Name:ROBINSON-WHIPPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 N MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3820
Mailing Address - Country:US
Mailing Address - Phone:559-438-0980
Mailing Address - Fax:
Practice Address - Street 1:6572 N MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3820
Practice Address - Country:US
Practice Address - Phone:559-438-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107203318310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility