Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 1116478 | AL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1116478 | AL |
NPI | 1013282987 |
---|---|
Provider Name | Larissa Robinson |
First Address | Jasper, AL 35502-1571 |
Second Address | Jasper, AL 35504-7058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2012 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
541003878 | (05) | AL |