Provider Demographics
NPI:1861806101
Name:ROBINSON, VANITA SUZANNI (ANP-BC)
Entity type:Individual
Prefix:
First Name:VANITA
Middle Name:SUZANNI
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1234 MEADOWBROOK ST
Mailing Address - Street 2:1234 MEADOWBROOK
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3620
Mailing Address - Country:US
Mailing Address - Phone:313-821-0667
Mailing Address - Fax:313-821-5727
Practice Address - Street 1:15474 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4893
Practice Address - Country:US
Practice Address - Phone:734-335-6103
Practice Address - Fax:734-404-5317
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242745363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care