Provider Demographics
NPI:1336431154
Name:ROBINSON, CHAD (NP-C)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 NW MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7501
Mailing Address - Country:US
Mailing Address - Phone:503-415-4060
Mailing Address - Fax:506-415-4061
Practice Address - Street 1:2127 NW MILLER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-7501
Practice Address - Country:US
Practice Address - Phone:503-415-4060
Practice Address - Fax:506-415-4061
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61140382363LF0000X
OR201250197NP363LP2300X
AK172841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336431154Medicaid
WI01560--0059Medicare PIN