Basic Information
| Provider Information | |||||||||
| NPI: | 1821640616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTYRE | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 AEGEAN WAY APT 58 | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956874074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076282873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 CHADBOURNE RD STE A | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074198989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2019 | ||||||||
| LastUpdateDate: | 12/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95012034 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.