Provider Demographics
NPI:1861770562
Name:TALAFUSE, NORA BOLANOS (RD, LD, CNSC)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:BOLANOS
Last Name:TALAFUSE
Suffix:
Gender:F
Credentials:RD, LD, CNSC
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:PATRICIA
Other - Last Name:BOLANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, CNSC
Mailing Address - Street 1:4343 N JOSEY LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4343 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4603
Practice Address - Country:US
Practice Address - Phone:972-394-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06788133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered