Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 000004011 | CA |
NPI | 1235388232 |
---|---|
Provider Name | Mark William Robinson |
First Address | Yreka, CA 96097-3474 |
Second Address | Yreka, CA 96097-3474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2008 |
Last Update Date | 30/03/2017 |