Provider Demographics
NPI:1629300611
Name:VANNESS, RANDEE P (MS)
Entity Type:Individual
Prefix:
First Name:RANDEE
Middle Name:P
Last Name:VANNESS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 FLINTRIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4273
Mailing Address - Country:US
Mailing Address - Phone:719-510-6313
Mailing Address - Fax:719-358-7756
Practice Address - Street 1:4740 FLINTRIDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4273
Practice Address - Country:US
Practice Address - Phone:719-510-6313
Practice Address - Fax:719-358-7756
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist