Provider Demographics
NPI:1881762722
Name:ROBINETT, DEBORA (MA, RD)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:ROBINETT
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99121
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-0121
Mailing Address - Country:US
Mailing Address - Phone:253-566-1616
Mailing Address - Fax:253-582-3091
Practice Address - Street 1:1812 S J ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4965
Practice Address - Country:US
Practice Address - Phone:253-556-1616
Practice Address - Fax:253-582-3091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0361820OtherCIGNA
WAP06733OtherREGENCE INS CO