Provider Demographics
NPI:1255216115
Name:GRAUMENZ, ROBIN MACKENZIE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:ROBIN MACKENZIE
Middle Name:
Last Name:GRAUMENZ
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19188 PEMBROOK
Mailing Address - Street 2:
Mailing Address - City:MARTHASVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63357-2647
Mailing Address - Country:US
Mailing Address - Phone:618-267-5898
Mailing Address - Fax:618-267-5898
Practice Address - Street 1:19188 PEMBROOK
Practice Address - Street 2:
Practice Address - City:MARTHASVILLE
Practice Address - State:MO
Practice Address - Zip Code:63357-2647
Practice Address - Country:US
Practice Address - Phone:618-267-5898
Practice Address - Fax:618-267-5898
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012036896163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant