Provider Demographics
NPI:1801621438
Name:WAITE, VIKTORIIA (RDN)
Entity type:Individual
Prefix:
First Name:VIKTORIIA
Middle Name:
Last Name:WAITE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 LE BRON RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2334
Mailing Address - Country:US
Mailing Address - Phone:334-710-4670
Mailing Address - Fax:
Practice Address - Street 1:3202 LE BRON RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2334
Practice Address - Country:US
Practice Address - Phone:334-710-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5343133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered