Provider Demographics
NPI:1447925037
Name:ROBINSON, SAMUEL N
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:N
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 GREEN VALLEY DR APT 1
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-1286
Mailing Address - Country:US
Mailing Address - Phone:608-774-9715
Mailing Address - Fax:
Practice Address - Street 1:1638 GREEN VALLEY DR APT 1
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1286
Practice Address - Country:US
Practice Address - Phone:608-774-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR7947533206