1134805351 NPI number — JULIANNE BORNIA ROBINSON CPM, LM

Table of content: JULIANNE BORNIA ROBINSON CPM, LM (NPI 1134805351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134805351 NPI number — JULIANNE BORNIA ROBINSON CPM, LM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
JULIANNE
Provider Middle Name:
BORNIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPM, LM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
JULIANNE
Provider Other Middle Name:
BORNIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134805351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 W KOOTENAI ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83705-2329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-640-7727
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4041 S ARGONAUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83709-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-213-2930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  MID-147 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)