Provider Demographics
NPI:1417605304
Name:ROBINSON, LESLIE JO
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JO
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5439
Mailing Address - Country:US
Mailing Address - Phone:219-736-7300
Mailing Address - Fax:219-736-7304
Practice Address - Street 1:120 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5439
Practice Address - Country:US
Practice Address - Phone:219-736-7300
Practice Address - Fax:219-736-7304
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment