Individual
MICHELLE ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001-8642
(307) 739-7361
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
192
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155255400
—
WY
Enumeration date
12/19/2019
Last updated
02/18/2021
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