Provider Demographics
NPI:1265745525
Name:POGUE, STEPHANIE LYNN (RD, RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:POGUE
Suffix:
Gender:F
Credentials:RD, RN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:ROSENBURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:546 ROBINDALE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4082
Mailing Address - Country:US
Mailing Address - Phone:585-261-0433
Mailing Address - Fax:
Practice Address - Street 1:546 ROBINDALE DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4082
Practice Address - Country:US
Practice Address - Phone:585-261-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011361133V00000X
TXDT90983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered