Provider Demographics
NPI:1063653012
Name:MARTIN, ROBIN RENEE (RN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 LAWRENCE ROAD 269
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72466-8015
Mailing Address - Country:US
Mailing Address - Phone:870-528-1408
Mailing Address - Fax:
Practice Address - Street 1:1710 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7303
Practice Address - Country:US
Practice Address - Phone:870-262-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR32493163W00000X
CA723886163W00000X
MO2007031666163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse