Healthcare Provider Details

I. General information

NPI: 1528281300
Provider Name (Legal Business Name): JUDE TRAUTLEIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2764 N WARREN AVE
TUCSON AZ
85719-3142
US

IV. Provider business mailing address

2509 N CAMPBELL AVE #122
TUCSON AZ
85719-3304
US

V. Phone/Fax

Practice location:
  • Phone: 520-235-0307
  • Fax:
Mailing address:
  • Phone: 520-235-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: