Basic Information
| Provider Information | |||||||||
| NPI: | 1053382267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | C-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 927 | ||||||||
| Address2: | 5 E. ALVON ROAD | ||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249862373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045365030 | ||||||||
| FaxNumber: | 3045365031 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 KING STREET | ||||||||
| Address2: | CENTRA SOUTHSIDE PROFESSIONAL LLC | ||||||||
| City: | KEYSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 239373659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4343152998 | ||||||||
| FaxNumber: | 4343928191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 10/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP-05484 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 17139457 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2367657 | 05 | OH | MEDICAID | 500027170 | 01 | RAILROAD MEDICARE | OTHER | 61459601 | 01 | VA | BLACK LUNG/FECA | OTHER | 021475C59 | 01 | VA | VA PTAN NUMBER | OTHER | 000000342755 | 01 | OH | ANTHEM | OTHER |