Provider Demographics
NPI:1124578372
Name:CRILE, VALERIE
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:
Last Name:CRILE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:VALERIE
Other - Last Name:TRUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,LDN,IBCLC
Mailing Address - Street 1:15481 W CLUB DELUXE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1466
Mailing Address - Country:US
Mailing Address - Phone:985-543-4880
Mailing Address - Fax:
Practice Address - Street 1:15481 W CLUB DELUXE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1466
Practice Address - Country:US
Practice Address - Phone:985-543-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1627133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered