Provider Demographics
NPI:1346836277
Name:ROEBUCK, KIRSTIN (RDN)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:ROEBUCK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1027
Mailing Address - Country:US
Mailing Address - Phone:717-421-2622
Mailing Address - Fax:
Practice Address - Street 1:2201 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1027
Practice Address - Country:US
Practice Address - Phone:717-421-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered