Provider Demographics
NPI:1619321973
Name:POLLEY, VALERIE LYNN (RDN, CD)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:LYNN
Last Name:POLLEY
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13654 FIELDSHIRE TER
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8238
Mailing Address - Country:US
Mailing Address - Phone:410-963-4782
Mailing Address - Fax:
Practice Address - Street 1:13654 FIELDSHIRE TER
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46074-8238
Practice Address - Country:US
Practice Address - Phone:410-963-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001243A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered