Provider Demographics
NPI:1518606565
Name:VANDENBERG, ELLEN LEIGH (RNFA)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LEIGH
Last Name:VANDENBERG
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 PEPONITA CT
Mailing Address - Street 2:
Mailing Address - City:WASHOE VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89704-9648
Mailing Address - Country:US
Mailing Address - Phone:775-737-1818
Mailing Address - Fax:
Practice Address - Street 1:188 PEPONITA CT
Practice Address - Street 2:
Practice Address - City:WASHOE VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89704-9648
Practice Address - Country:US
Practice Address - Phone:775-737-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN26316163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty