Basic Information
Provider Information
NPI: 1114991825
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AGNEW
FirstName: ROBYN
MiddleName: MICHELLE
NamePrefix:  
NameSuffix:  
Credential: CNM, NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4910 E CLINTON WAY
Address2: SUITE 101
City: FRESNO
State: CA
PostalCode: 937271560
CountryCode: US
TelephoneNumber: 5594432682
FaxNumber: 5594432681
Practice Location
Address1: 290 N WAYTE LN
Address2:  
City: FRESNO
State: CA
PostalCode: 937012124
CountryCode: US
TelephoneNumber: 5594595755
FaxNumber: 5594594454
Other Information
ProviderEnumerationDate: 02/17/2006
LastUpdateDate: 12/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN365884CAN Nursing Service ProvidersRegistered Nurse 
363L00000XNP9944CAN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LX0001XNP9944CAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
367A00000XNMW1431CAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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