1366750796 NPI number — MRS. CRYSTAL GERVAIS ROBINSON R.D., L.D.

Table of content: MRS. CRYSTAL GERVAIS ROBINSON R.D., L.D. (NPI 1366750796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366750796 NPI number — MRS. CRYSTAL GERVAIS ROBINSON R.D., L.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
CRYSTAL
Provider Middle Name:
GERVAIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D., L.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GERVAIS
Provider Other First Name:
CRYSTAL
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366750796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 SHILOH CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29642-8392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-455-4041
Provider Business Mailing Address Fax Number:
864-455-8447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 SHILOH CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASLEY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29642-8392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-455-4041
Provider Business Practice Location Address Fax Number:
864-455-8447
Provider Enumeration Date:
09/20/2010

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:  47 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com