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NPI Code Detail

MEDICARE: HEIDI W ROBERTS RD

MEDICARE: HEIDI W ROBERTS RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133NN1002XNutrition Education Nutritionist
2133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1396931515
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI W ROBERTS RD
Provider Business Mailing Address
First Line : PO BOX 5299
Second Line : MAIL STOP 737-2-PHYS
City : TACOMA
State : WA
Zip : 98415-0299
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 315 MARTIN LUTHER KING JR WAY
Second Line :
City : TACOMA
State : WA
Zip : 98405-4234
Country : US
Telephone Number : 253-403-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2007
Last Update Date : 09/20/2007

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Directions to “ HEIDI W ROBERTS RD” Practice Location

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