Provider Demographics
NPI:1962746198
Name:ROBINSON, MAXIE L (BS)
Entity type:Individual
Prefix:MRS
First Name:MAXIE
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 LYNCREST DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3516
Mailing Address - Country:US
Mailing Address - Phone:615-618-0890
Mailing Address - Fax:
Practice Address - Street 1:2865 LYNCREST DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3516
Practice Address - Country:US
Practice Address - Phone:615-618-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0171000000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNUNKNOWNMedicaid
TNUNKNOWNOtherMEDICARE