Provider Demographics
NPI:1255516480
Name:ROBINSON, JANUARY ALAINE (NP)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:ALAINE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANUARY
Other - Middle Name:ALAINE
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1401 LAKEWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3352
Mailing Address - Country:US
Mailing Address - Phone:815-942-6323
Mailing Address - Fax:815-942-6423
Practice Address - Street 1:1401 LAKEWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3352
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:815-942-6423
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF1007078363LF0000X
IL2018086679363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL383121001Medicare UPIN