Provider Demographics
NPI:1588856975
Name:JERDAN, DULCIA (RD)
Entity Type:Individual
Prefix:
First Name:DULCIA
Middle Name:
Last Name:JERDAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DULCIA
Other - Middle Name:
Other - Last Name:FRISINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:505 E CAPOVILLA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4340
Mailing Address - Country:US
Mailing Address - Phone:702-260-7329
Mailing Address - Fax:
Practice Address - Street 1:505 E CAPOVILLA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4340
Practice Address - Country:US
Practice Address - Phone:702-260-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
882891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered