Provider Demographics
NPI:1518130285
Name:ROBERTSON, ERIN MCCUISTON (RD, LDN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MCCUISTON
Last Name:ROBERTSON
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 1:175 ERICKSON DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-7482
Mailing Address - Country:US
Mailing Address - Phone:931-363-8693
Mailing Address - Fax:
Practice Address - Street 1:2379 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4810
Practice Address - Country:US
Practice Address - Phone:931-762-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000001341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3241141Medicare Oscar/Certification