Provider Demographics
NPI:1376249300
Name:ROBERTSON, HILARY (RDN, LD, MS)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RDN, LD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65661-0158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 N GRAND ST STE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-8198
Practice Address - Country:US
Practice Address - Phone:417-637-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019041277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered