Provider Demographics
NPI:1720310725
Name:ROBERTSON, ALISSA C (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I10 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7184
Mailing Address - Country:US
Mailing Address - Phone:802-999-5684
Mailing Address - Fax:
Practice Address - Street 1:426 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4448
Practice Address - Country:US
Practice Address - Phone:802-999-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074.0066727133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered