Provider Demographics
NPI:1285276303
Name:ROBB, VIDA (CRNP-PMH)
Entity type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:
Last Name:ROBB
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14519 TURNER WOOTTON PKWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8693
Mailing Address - Country:US
Mailing Address - Phone:240-486-9899
Mailing Address - Fax:301-383-0404
Practice Address - Street 1:14519 TURNER WOOTTON PKWY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8693
Practice Address - Country:US
Practice Address - Phone:240-486-9899
Practice Address - Fax:949-543-2361
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health