Provider Demographics
NPI:1972634723
Name:ILLIAN, ROBIN ED (CPM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ED
Last Name:ILLIAN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:E
Other - Last Name:DOOLITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM
Mailing Address - Street 1:33 EDGEWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2411
Mailing Address - Country:US
Mailing Address - Phone:207-233-6888
Mailing Address - Fax:207-591-4767
Practice Address - Street 1:11 RIVER RD
Practice Address - Street 2:
Practice Address - City:LIMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04049-3709
Practice Address - Country:US
Practice Address - Phone:207-233-6888
Practice Address - Fax:207-591-4767
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife