Basic Information
| Provider Information | |||||||||
| NPI: | 1740903012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 TIP AVE | ||||||||
| Address2: | |||||||||
| City: | OGLESBY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613481340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153472402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 535 PARK AVE E | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613562537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8158754531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 209025937 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.