Provider Demographics
NPI:1033659982
Name:NOLLMEYER, VIRGINIA (RDN, LD, LN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:NOLLMEYER
Suffix:
Gender:F
Credentials:RDN, LD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3216
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59772-3216
Mailing Address - Country:US
Mailing Address - Phone:406-600-5193
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR
Practice Address - Street 2:UNIT 109
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6995
Practice Address - Country:US
Practice Address - Phone:406-600-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT51628133N00000X, 133V00000X
MN3799133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist