Provider Demographics
NPI:1073198008
Name:WALDEN, NICOLE BONDURIS (MS, LMT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:BONDURIS
Last Name:WALDEN
Suffix:
Gender:F
Credentials:MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 AUSTIN HWY APT 1301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-7502
Mailing Address - Country:US
Mailing Address - Phone:940-368-2328
Mailing Address - Fax:
Practice Address - Street 1:1320 AUSTIN HWY APT 1301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-7502
Practice Address - Country:US
Practice Address - Phone:940-368-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education