1497198329 NPI number — MS. ROBIN L WALTENBERGER RDN LPCC

Table of content: MS. ROBIN L WALTENBERGER RDN LPCC (NPI 1497198329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497198329 NPI number — MS. ROBIN L WALTENBERGER RDN LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTENBERGER
Provider First Name:
ROBIN
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDN LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALTENBERGER
Provider Other First Name:
ROBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN LPCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497198329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44273-9504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-769-5696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 WADSWORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADSWORTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44281-9503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-730-7353
Provider Business Practice Location Address Fax Number:
330-334-2235
Provider Enumeration Date:
04/10/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  900303 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133N00000X , with the licence number: LD 4757 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: LD 4757 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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