Provider Demographics
NPI:1952661878
Name:BRUNELL, ROBYN (RD, LDN, RN)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:
Last Name:BRUNELL
Suffix:
Gender:F
Credentials:RD, LDN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:KUNKLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18058-7770
Mailing Address - Country:US
Mailing Address - Phone:570-977-3108
Mailing Address - Fax:
Practice Address - Street 1:265 DEER PATH
Practice Address - Street 2:
Practice Address - City:KUNKLETOWN
Practice Address - State:PA
Practice Address - Zip Code:18058-7770
Practice Address - Country:US
Practice Address - Phone:570-977-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000597133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered