Provider Demographics
NPI:1528258860
Name:ROBINSON, MIEA JOVANNI ELISE (LPN)
Entity type:Individual
Prefix:
First Name:MIEA
Middle Name:JOVANNI ELISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 AQUADUCT PARK
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8030
Mailing Address - Country:US
Mailing Address - Phone:419-810-9074
Mailing Address - Fax:
Practice Address - Street 1:8433 AQUADUCT PARK
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8030
Practice Address - Country:US
Practice Address - Phone:419-810-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 112760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse