Provider Demographics
NPI:1871130385
Name:WALTERS, ALLISON DANIEL (RD, LD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DANIEL
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HALTON RD STE F5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3496
Mailing Address - Country:US
Mailing Address - Phone:864-326-0642
Mailing Address - Fax:864-676-7253
Practice Address - Street 1:301 HALTON RD STE F5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3496
Practice Address - Country:US
Practice Address - Phone:864-326-0642
Practice Address - Fax:864-676-7253
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered