Provider Demographics
NPI:1568635993
Name:TRUDELL, MELONIE S (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:S
Last Name:TRUDELL
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 HALL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INCHELIUM
Mailing Address - State:WA
Mailing Address - Zip Code:99138-9503
Mailing Address - Country:US
Mailing Address - Phone:509-722-7060
Mailing Address - Fax:509-722-7088
Practice Address - Street 1:2510 HALL CREEK RD
Practice Address - Street 2:
Practice Address - City:INCHELIUM
Practice Address - State:WA
Practice Address - Zip Code:99138-9503
Practice Address - Country:US
Practice Address - Phone:509-722-7060
Practice Address - Fax:509-722-7088
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA845854133VN1006X
WA20420488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No174400000XOther Service ProvidersSpecialist