Provider Demographics
NPI:1306885678
Name:HURLEY, ROBERTA S (RD, LD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:S
Last Name:HURLEY
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3320
Mailing Address - Country:US
Mailing Address - Phone:614-234-0100
Mailing Address - Fax:614-573-6674
Practice Address - Street 1:1144 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1039
Practice Address - Country:US
Practice Address - Phone:614-234-0100
Practice Address - Fax:614-234-0185
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered