Provider Demographics
NPI:1861152399
Name:WROBLEWSKI, ROXANA VANESA (RDN)
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:VANESA
Last Name:WROBLEWSKI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 BLOOMSBURY PL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-2845
Mailing Address - Country:US
Mailing Address - Phone:972-369-3039
Mailing Address - Fax:
Practice Address - Street 1:5979 BLOOMSBURY PL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-2845
Practice Address - Country:US
Practice Address - Phone:972-369-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86109363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT87177OtherTDLR - TEXAS DEPARTMENT OF LICENSING AND REGISTRATION
86109363OtherCDR - COMISSION ON DIETETIC REGISTRATION