Provider Demographics
NPI:1497129019
Name:VANDER LINDEN, NANCY (RD CD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:VANDER LINDEN
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:MUNGARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CD
Mailing Address - Street 1:9040 REID ST
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:
Practice Address - City:JOINT BASE LEWIS MCCHORD
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60443497133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered