Provider Demographics
NPI:1043719016
Name:BROEN, ROBIN LYNN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:BROEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:FREITAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11554 ZION STREET NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:612-730-6243
Mailing Address - Fax:
Practice Address - Street 1:3012 129TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2462314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse