Trevor Waldoch, CN

Primary specialty

Nutrition Education NutritionistTaxonomy code 133NN1002X

License

61559225 Issued in WA

Practice address

206 N 24TH Ave
Yakima, WA 98902-2366

Phone

(651) 249-3834

NPI assigned

Jun 21, 2024

Last updated

Jun 21, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1114761442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N 24TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989022366",
            "telephone_number": "651-249-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N 24TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989022366",
            "telephone_number": "651-249-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDOCH",
        "first_name": "TREVOR",
        "credential": "CN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-21",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "WA",
            "license": "61559225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Michael Waits, LPN
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• Arissa Rose Walberg, PHD
• Adela Constantin Waldie, PHARM D
• Walgreen Co (Walgreens #12053)
• Walgreen Co (Walgreens #12275)
• Walgreen Co (Walgreens #09911)
• Kevin J Walkenhauer, PA-C
• Andrea Walker

• Nutrition Education Nutritionist in Yakima, WA
• Providers in Yakima, WA by specialty
• Nutrition Education Nutritionist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.