Provider Demographics
NPI:1083189278
Name:VERMEULEN, ELIZABETH (RD, CNSC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VERMEULEN
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 VALLEY RIDGE DR APT 7
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4048
Mailing Address - Country:US
Mailing Address - Phone:269-267-8097
Mailing Address - Fax:
Practice Address - Street 1:4119 VALLEY RIDGE DR APT 7
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4048
Practice Address - Country:US
Practice Address - Phone:269-267-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered