Provider Demographics
NPI:1932429925
Name:PRENDERGAST, ROBIN MICAL (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICAL
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:MICAL
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1481 WEST 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-9779
Mailing Address - Fax:317-988-5323
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-9779
Practice Address - Fax:317-988-5323
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN281454945A163W00000X
IN71003318A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse