Provider Demographics
NPI:1104924646
Name:ROBINSON, LUEZARAH
Entity type:Individual
Prefix:MRS
First Name:LUEZARAH
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 LIVINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MS
Mailing Address - Zip Code:39769-4528
Mailing Address - Country:US
Mailing Address - Phone:662-617-3277
Mailing Address - Fax:
Practice Address - Street 1:133 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-2709
Practice Address - Country:US
Practice Address - Phone:662-813-5151
Practice Address - Fax:662-813-5152
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP303655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09328808Medicaid
MS08575397Medicaid