Provider Demographics
NPI:1316119951
Name:BIANCO, ROBYN LEE (ANP)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:LEE
Last Name:BIANCO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BRADLEE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3110
Mailing Address - Country:US
Mailing Address - Phone:781-395-1110
Mailing Address - Fax:781-395-8553
Practice Address - Street 1:13 BRADLEE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3110
Practice Address - Country:US
Practice Address - Phone:781-395-1110
Practice Address - Fax:781-395-8553
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194216363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ10473OtherMEDICAIRE