Provider Demographics
NPI:1518346790
Name:VANECK, MARY (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:VANECK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6729
Mailing Address - Country:US
Mailing Address - Phone:512-423-9958
Mailing Address - Fax:
Practice Address - Street 1:1612 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6729
Practice Address - Country:US
Practice Address - Phone:512-423-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered