Provider Demographics
NPI:1740226521
Name:WALTON, RHONDA L (RD CD LD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:WALTON
Suffix:
Gender:F
Credentials:RD CD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 JUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2517
Mailing Address - Country:US
Mailing Address - Phone:260-485-1410
Mailing Address - Fax:574-267-2406
Practice Address - Street 1:5927 JUSTIN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2517
Practice Address - Country:US
Practice Address - Phone:260-485-1410
Practice Address - Fax:574-267-2406
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001608A133V00000X
OHLD 5173133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWAMT02681Medicare ID - Type UnspecifiedPROVIDER NO.
IN213960IMedicare ID - Type UnspecifiedPROVIDER NO