Provider Demographics
NPI:1144407438
Name:RICHARDSON, ROBIN CECILE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:CECILE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:CECILE
Other - Last Name:OERTLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD/MBA
Mailing Address - Street 1:4016 MYERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-7333
Mailing Address - Country:US
Mailing Address - Phone:972-484-6023
Mailing Address - Fax:
Practice Address - Street 1:701 W SIMONDS RD
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-3201
Practice Address - Country:US
Practice Address - Phone:972-287-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered