Basic Information
| Provider Information | |||||||||
| NPI: | 1801823075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | GWENDOLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1049 REDEMPTION WAY | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630342055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143956900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12098 LUSHER RD. | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843513238 | ||||||||
| FaxNumber: | 6108621547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 075346 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.