Provider Demographics
NPI:1881573723
Name:HEBARD, ROBIN MARIE (RD, CSOWM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:HEBARD
Suffix:
Gender:F
Credentials:RD, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3412
Mailing Address - Country:US
Mailing Address - Phone:410-302-9141
Mailing Address - Fax:
Practice Address - Street 1:42 N SAINT JOSEPH AVE STE 100
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-687-4673
Practice Address - Fax:269-687-1798
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86019667133V00000X, 133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered