Provider Demographics
NPI:1568067007
Name:ROEN, DEVIN ELISE (RDN, MS, CPT)
Entity Type:Individual
Prefix:MS
First Name:DEVIN
Middle Name:ELISE
Last Name:ROEN
Suffix:
Gender:F
Credentials:RDN, MS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 E 143RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1306
Mailing Address - Country:US
Mailing Address - Phone:715-441-4521
Mailing Address - Fax:
Practice Address - Street 1:434 E 143RD ST APT 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-1306
Practice Address - Country:US
Practice Address - Phone:715-441-4521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009887133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological