Provider Demographics
NPI:1750703401
Name:ALLEN, ROBIN R (MSPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-6163
Mailing Address - Country:US
Mailing Address - Phone:217-356-6543
Mailing Address - Fax:217-356-8010
Practice Address - Street 1:2906 CROSSING CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-6163
Practice Address - Country:US
Practice Address - Phone:217-356-6543
Practice Address - Fax:217-356-8010
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.002633133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164.002633OtherSTATE OF IL