Basic Information
| Provider Information | |||||||||
| NPI: | 1386365443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | SERWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4633 W SAMPLE AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937227900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507046129 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 WEST CLINTON AVENUE | ||||||||
| Address2: | BUILDING A SUITE 116 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592647521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2022 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 228122 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.