Provider Demographics
NPI:1619063757
Name:REDWING WHITE, VALINDA JEANNE
Entity Type:Individual
Prefix:MS
First Name:VALINDA
Middle Name:JEANNE
Last Name:REDWING WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VALINDA
Other - Middle Name:JEANNE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:100 LAKE TRAVERSE DRIVE
Mailing Address - Street 2:WW KEEBLE MEMORIAL HEALTH CARE CENTER
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-7046
Mailing Address - Country:US
Mailing Address - Phone:605-742-3631
Mailing Address - Fax:605-742-3896
Practice Address - Street 1:100 LAKE TRAVERSE DRIVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262
Practice Address - Country:US
Practice Address - Phone:605-742-3631
Practice Address - Fax:605-742-3896
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0116133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RD835709OtherAMERICAN DIETETIC ASSOCIA
SD0116OtherLICENSED NUTRITIONIST
SD0116OtherLICENSED NUTRITIONIST