Provider Demographics
NPI:1124255955
Name:ROBINSON, BRENDA GAIL (LPN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:GAIL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3808
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3808
Mailing Address - Country:US
Mailing Address - Phone:410-341-3649
Mailing Address - Fax:410-341-3649
Practice Address - Street 1:2703 DAWSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31903-1342
Practice Address - Country:US
Practice Address - Phone:443-669-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP28370164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse