Basic Information
| Provider Information | |||||||||
| NPI: | 1891020889 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8325 NW EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731626006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057497099 | ||||||||
| FaxNumber: | 4057739437 | ||||||||
| Practice Location | |||||||||
| Address1: | 8325 NW EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731626006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057497099 | ||||||||
| FaxNumber: | 4057739437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 06/21/2014 | ||||||||
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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 | 163W00000X | 0070963 | OK | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 200265450A | 05 | OK | MEDICAID |