Provider Demographics
NPI:1528209558
Name:ROOFE, NINA L (MS, R, D, L D)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:L
Last Name:ROOFE
Suffix:
Gender:F
Credentials:MS, R, D, L D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SARAH LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-9049
Mailing Address - Country:US
Mailing Address - Phone:501-680-3281
Mailing Address - Fax:
Practice Address - Street 1:12 SARAH LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-9049
Practice Address - Country:US
Practice Address - Phone:501-680-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-21
Last Update Date:2009-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered