Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2633715 | ND |
Y | 213ES0000X | Sports Medicine | 2633715 | ND |
NPI | 1104390764 |
---|---|
Provider Name | Nina Magdalena Robinson |
First Address | Fargo, ND 58105-2504 |
Second Address | Fargo, ND 58102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 17/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2633715 | (05) | ND |