Provider Demographics
NPI:1912100538
Name:ROBINSON, STEPHANIE R (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1880
Mailing Address - Country:US
Mailing Address - Phone:317-571-0030
Mailing Address - Fax:
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-571-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002519A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201094850Medicaid
IN200969430Medicaid
IN201094850Medicaid
INP01180692Medicare PIN
IN267030KMedicare PIN
IN165460C5Medicare PIN