Provider Demographics
NPI:1083507735
Name:WAGNER, ROBYN (RD, LDN)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SWEET ARROW DR
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-2721
Mailing Address - Country:US
Mailing Address - Phone:717-592-8148
Mailing Address - Fax:
Practice Address - Street 1:31 SWEET ARROW DR
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-2721
Practice Address - Country:US
Practice Address - Phone:717-592-8148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA916226133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered