Healthcare Provider Details

I. General information

NPI: 1306885678
Provider Name (Legal Business Name): ROBERTA S. HURLEY R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 DUBLIN RD
COLUMBUS OH
43215-1039
US

IV. Provider business mailing address

2727 NORTHWEST BLVD
COLUMBUS OH
43221-3320
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-0100
  • Fax: 614-234-0185
Mailing address:
  • Phone: 614-234-0100
  • Fax: 614-573-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number374
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: