Provider Demographics
NPI:1962802645
Name:GREGORY, ROBBIN R (LMP)
Entity type:Individual
Prefix:
First Name:ROBBIN
Middle Name:R
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ROBBIN
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LE
Mailing Address - Street 1:1131 SCHRAEDER RD.
Mailing Address - Street 2:POB 552
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947
Mailing Address - Country:US
Mailing Address - Phone:509-731-2228
Mailing Address - Fax:
Practice Address - Street 1:3910 SUMMITVIEW AVE STE 210
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2780
Practice Address - Country:US
Practice Address - Phone:509-966-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60500925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist