Provider Demographics
NPI:1700165339
Name:ROBINSON, RONALD W JR (STNA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 W 64TH ST
Mailing Address - Street 2:APT. #3
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2140
Mailing Address - Country:US
Mailing Address - Phone:216-245-7596
Mailing Address - Fax:
Practice Address - Street 1:1391 W 64TH ST
Practice Address - Street 2:APT. #3
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2140
Practice Address - Country:US
Practice Address - Phone:216-245-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH400081460202376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide