Provider Demographics
NPI:1649600123
Name:SPANGLER, ANDREA M (RD, CSP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MASEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219
Practice Address - Country:US
Practice Address - Phone:804-828-2467
Practice Address - Fax:804-628-0267
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARD000967639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered