Provider Demographics
NPI:1649953316
Name:DROCHELMAN, HOLLEY (MS, RDN, LD, CEDS)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:
Last Name:DROCHELMAN
Suffix:
Gender:F
Credentials:MS, RDN, LD, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 MEADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3016
Mailing Address - Country:US
Mailing Address - Phone:205-563-9651
Mailing Address - Fax:
Practice Address - Street 1:13100 MANCHESTER RD STE 175
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-1729
Practice Address - Country:US
Practice Address - Phone:205-563-9651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered