Provider Demographics
NPI:1992277495
Name:VAN VALKENBURGH, ERIN ANN (RDN)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ANN
Last Name:VAN VALKENBURGH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 70TH CT
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3760
Mailing Address - Country:US
Mailing Address - Phone:805-696-8302
Mailing Address - Fax:
Practice Address - Street 1:5426 70TH CT
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3760
Practice Address - Country:US
Practice Address - Phone:805-696-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered