Provider Demographics
NPI:1801374780
Name:MOUZAYEN, WALAA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:WALAA
Middle Name:
Last Name:MOUZAYEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16216 BAXTER RD STE 190
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4771
Mailing Address - Country:US
Mailing Address - Phone:636-778-1515
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD STE 190
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4771
Practice Address - Country:US
Practice Address - Phone:636-778-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001062133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric