Provider Demographics
NPI:1568928711
Name:WALTER-TROGDON, ADELLE R (NC)
Entity Type:Individual
Prefix:
First Name:ADELLE
Middle Name:R
Last Name:WALTER-TROGDON
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 SHERRILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2620
Mailing Address - Country:US
Mailing Address - Phone:469-879-3931
Mailing Address - Fax:
Practice Address - Street 1:414 SHERRILL BLVD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2620
Practice Address - Country:US
Practice Address - Phone:469-879-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist