Provider Demographics
NPI:1881712537
Name:WATROUS, CHERYL D (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:D
Last Name:WATROUS
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4347
Mailing Address - Country:US
Mailing Address - Phone:256-351-1990
Mailing Address - Fax:256-351-9915
Practice Address - Street 1:1310 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4347
Practice Address - Country:US
Practice Address - Phone:256-351-1990
Practice Address - Fax:256-351-9915
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0962-0545133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered