1396850590 NPI number — MRS. RAINA L ROBINSON DC

Table of content: MRS. RAINA L ROBINSON DC (NPI 1396850590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396850590 NPI number — MRS. RAINA L ROBINSON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
RAINA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NELLENBACK
Provider Other First Name:
RAINA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396850590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 126
Provider Second Line Business Mailing Address:
11444 STATE ROUTE 12
Provider Business Mailing Address City Name:
ALDER CREEK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-831-3913
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11444 ST. RT. 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALDER CREEK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13301-0126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-831-3913
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006

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: 111N00000X , with the licence number:  X0093541 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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