Provider Demographics
NPI:1346616430
Name:ROBERTSON, TWYLA B (RD/LD)
Entity Type:Individual
Prefix:
First Name:TWYLA
Middle Name:B
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4427
Mailing Address - Country:US
Mailing Address - Phone:469-767-7618
Mailing Address - Fax:
Practice Address - Street 1:2833 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-4427
Practice Address - Country:US
Practice Address - Phone:469-767-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered