Provider Demographics
NPI:1902136369
Name:WOLLARD, ROBIN (FNP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WOLLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 S LIMIT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-1179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 S LIMIT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-1179
Practice Address - Country:US
Practice Address - Phone:660-851-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO089371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily