Provider Demographics
NPI:1780238733
Name:JORUD, INGRID (MS, RD, LD, CPT)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:JORUD
Suffix:
Gender:F
Credentials:MS, RD, LD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131 MARSEILLE PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3329
Mailing Address - Country:US
Mailing Address - Phone:218-205-7264
Mailing Address - Fax:
Practice Address - Street 1:7131 MARSEILLE PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3329
Practice Address - Country:US
Practice Address - Phone:505-596-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0892133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty