Provider Demographics
NPI:1578783213
Name:TRUMBULL, VIRGINIA K (RD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:K
Last Name:TRUMBULL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:K
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:911 E 20TH ST
Mailing Address - Street 2:PHYSICIANS OFFICE BUILDING, SUITE 600
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1042
Mailing Address - Country:US
Mailing Address - Phone:605-322-8995
Mailing Address - Fax:605-322-8994
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:PHYSICIANS OFFICE BUILDING, SUITE 600
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-8995
Practice Address - Fax:605-322-8994
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD 0161133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD40522Medicare ID - Type UnspecifiedAVERA MCKENNAN