Provider Demographics
NPI:1598894701
Name:SPILLANE, VICKIE L (MS RD CDE LDN)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:L
Last Name:SPILLANE
Suffix:
Gender:F
Credentials:MS RD CDE LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 KNOLLWOOD DR
Mailing Address - Street 2:INTEGRATIVE NUTRITION CARE
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1646
Mailing Address - Country:US
Mailing Address - Phone:856-482-2629
Mailing Address - Fax:
Practice Address - Street 1:97 KNOLLWOOD DR
Practice Address - Street 2:INTEGRATIVE NUTRITION CARE
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1646
Practice Address - Country:US
Practice Address - Phone:856-482-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
5463516OtherAETNA EPOB
2168990OtherAETNA GROUP
2168986OtherAETNA INDIVIDUAL
1015277OtherAMERICAN SPECIALTY HEALTH