Provider Demographics
NPI:1710588454
Name:DUELLEY, ELEANOR (MS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:DUELLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 ARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5627
Mailing Address - Country:US
Mailing Address - Phone:805-217-8239
Mailing Address - Fax:
Practice Address - Street 1:1122 ARBOR PARK DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5627
Practice Address - Country:US
Practice Address - Phone:805-217-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty