Healthcare Provider Details

I. General information

NPI: 1427191469
Provider Name (Legal Business Name): ALICIA R. WALTER R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OUTPATIENT NUTRITION EDUCATION BAYSTATE FMC 48 SANDERSON STREET
GREENFIELD MA
01301
US

IV. Provider business mailing address

216 MONTAGUE RD
SHUTESBURY MA
01072-9760
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-2669
  • Fax: 413-773-2176
Mailing address:
  • Phone: 413-259-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1246
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: