Provider Demographics
NPI:1720659832
Name:GARDINER, ROBIN WALTERS (RD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:WALTERS
Last Name:GARDINER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOREST FALLS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6937
Mailing Address - Country:US
Mailing Address - Phone:207-977-4700
Mailing Address - Fax:
Practice Address - Street 1:50 FOREST FALLS DR STE 3
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6937
Practice Address - Country:US
Practice Address - Phone:207-977-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDI1845OtherBOARD OF LICENSING OF DIETETIC PRACTICE