| Name | Value |
|---|---|
| PROVIDER TYPE | Dietary & Nutritional Service Providers |
| CLASSIFICATION | Dietitian, Registered |
| AREA OF SPECIALIZATION | Nutrition, Pediatric |
| STATUS | Active |
| VA CODE | V040402 |
| X12 CODE | 133VN1004X |
| SPECIALTY CODE | 71 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252543 |
| EFFECTIVE DATE/TIME |
|