Provider Demographics
NPI:1235455742
Name:SCRUGGS, ALBERTA M (LD / RD)
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:M
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:LD / RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4013
Mailing Address - Country:US
Mailing Address - Phone:937-367-1291
Mailing Address - Fax:
Practice Address - Street 1:4415 DAYTON LIBERTY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-5903
Practice Address - Country:US
Practice Address - Phone:937-268-6741
Practice Address - Fax:937-268-6804
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL6525133V00000X
OHF78220174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator