Provider Demographics
NPI:1629893599
Name:HURDELBRINK, JUDY MARIE (RD/LD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:HURDELBRINK
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 EMILEE RUTH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3634
Mailing Address - Country:US
Mailing Address - Phone:918-916-9710
Mailing Address - Fax:
Practice Address - Street 1:3418 EMILEE RUTH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3634
Practice Address - Country:US
Practice Address - Phone:918-916-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1069133V00000X
MO2019039984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered