Provider Demographics
NPI:1952573453
Name:EKSTROM, TRUDY BERNICE (CN, MS, PHD)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:BERNICE
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:CN, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 REGATTA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6891
Mailing Address - Country:US
Mailing Address - Phone:702-363-9260
Mailing Address - Fax:702-658-6721
Practice Address - Street 1:2620 REGATTA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6891
Practice Address - Country:US
Practice Address - Phone:702-363-9260
Practice Address - Fax:702-658-6721
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVH11-00044-C-096986133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist