Provider Demographics
NPI:1033258603
Name:WILSON, ELEANOR A (RD, MS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 NOTT ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-1812
Mailing Address - Country:US
Mailing Address - Phone:518-379-1272
Mailing Address - Fax:518-379-3390
Practice Address - Street 1:461 NOTT ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-1812
Practice Address - Country:US
Practice Address - Phone:518-379-1272
Practice Address - Fax:518-379-3390
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered