Healthcare Provider Details

I. General information

NPI: 1578783213
Provider Name (Legal Business Name): VIRGINIA K TRUMBULL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINGER K TRUMBULL RD

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E 20TH ST PHYSICIANS OFFICE BUILDING, SUITE 600
SIOUX FALLS SD
57105-1042
US

IV. Provider business mailing address

911 E 20TH ST PHYSICIANS OFFICE BUILDING, SUITE 600
SIOUX FALLS SD
57105-1042
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8995
  • Fax: 605-322-8994
Mailing address:
  • Phone: 605-322-8995
  • Fax: 605-322-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberSD 0161
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberSD 0161
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: