Provider Demographics
NPI:1447498118
Name:WALSH, NANCY LEE STORMS (RD, LN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE STORMS
Last Name:WALSH
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:STORMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:400 SOLDIER CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0400
Mailing Address - Country:US
Mailing Address - Phone:605-747-2231
Mailing Address - Fax:605-747-3254
Practice Address - Street 1:400 SOLDIER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0400
Practice Address - Country:US
Practice Address - Phone:605-747-2231
Practice Address - Fax:605-747-3254
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered