1124880380 NPI number — MRS. ROBIN RUTH PHIPPS RDN

Table of content: MRS. ROBIN RUTH PHIPPS RDN (NPI 1124880380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124880380 NPI number — MRS. ROBIN RUTH PHIPPS RDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHIPPS
Provider First Name:
ROBIN
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LITHGOW
Provider Other First Name:
ROBIN
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124880380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 E KENNEBEC RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACHIAS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04654-3533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-332-9633
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 E KENNEBEC RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACHIAS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04654-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-332-9633
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2024

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: 133V00000X , with the licence number:  DI1949 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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