Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 0050-01561 | NC |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 19708 | SC |
NPI | 1053384537 |
---|---|
Provider Name | Robin H Starr |
First Address | Myrtle Beach, SC 29572-5503 |
Second Address | Myrtle Beach, SC 29572-5503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 03/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100504506 | (05) | NV |
19708 | STATE LICENSE (01) | SC |
P61163 | (02) |