Provider Demographics
NPI:1679539134
Name:VIMONT, MANDEE E (CD)
Entity Type:Individual
Prefix:
First Name:MANDEE
Middle Name:E
Last Name:VIMONT
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:ST MARYS HOSPITAL/DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1849
Mailing Address - Country:US
Mailing Address - Phone:608-258-5020
Mailing Address - Fax:608-258-5020
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:ST MARYS HOSPITAL/DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1849
Practice Address - Country:US
Practice Address - Phone:608-258-5020
Practice Address - Fax:608-258-5020
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1743-029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60318OtherDEAN HEALTH INSURANCE
WIP00202776Medicare PIN
WIK400222980Medicare PIN
WI60318OtherDEAN HEALTH INSURANCE