Provider Demographics
NPI:1366829376
Name:ROBINSON, DOMINIQUE (RMA)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 COLUMBINE CT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-7217
Mailing Address - Country:US
Mailing Address - Phone:901-859-9390
Mailing Address - Fax:
Practice Address - Street 1:4706 COLUMBINE CT
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-7217
Practice Address - Country:US
Practice Address - Phone:901-859-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2598787302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization