Provider Demographics
NPI:1972014751
Name:ROBERTS, DENISE (MSRD)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MSRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 PINE PL
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2378
Mailing Address - Country:US
Mailing Address - Phone:715-651-2577
Mailing Address - Fax:
Practice Address - Street 1:1280 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-2202
Practice Address - Country:US
Practice Address - Phone:715-939-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered