Provider Demographics
NPI:1871720425
Name:TRUDEL, KIM ROBYN (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ROBYN
Last Name:TRUDEL
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 EAST 8TH STREET #2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127
Mailing Address - Country:US
Mailing Address - Phone:781-405-6135
Mailing Address - Fax:
Practice Address - Street 1:75 FINNELL DRIVE
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188
Practice Address - Country:US
Practice Address - Phone:781-682-5888
Practice Address - Fax:781-331-9155
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered