MEDICARE: RHONDA L. WALTON RD CD LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	37001608A	IN
2	133V00000X	Registered Dietitian	LD 5173	OH

General Provider Information

NPI Number	:	1740226521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA L. WALTON RD CD LD

Provider Business Mailing Address
First Line	:	5927 JUSTIN DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2517
Country	:	US
Telephone Number	:	260-485-1410
Fax Number	:	574-267-2406

Provider Business Practice Location Address
First Line	:	5927 JUSTIN DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-2517
Country	:	US
Telephone Number	:	260-485-1410
Fax Number	:	574-267-2406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	04/24/2008

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